Abstract Background Managing active ulcerative colitis (UC) in solid organ transplant recipients is challenging due to complex multidrug regimens and higher risks of complications. We assessed the efficacy and safety of vedolizumab in UC patients after liver transplantation (LT) who failed conventional treatment and were naïve to advanced therapies. Methods This multicenter retrospective study included adult post-LT patients with moderately to severely active UC (Mayo score ≥6) who were naïve to advanced therapies and received vedolizumab 300 mg intravenously at weeks 0, 2, and 6. Week-14 treatment response, required for therapy reimbursement, was defined as a ≥ 30% and ≥3-point Mayo score reduction; remission as Mayo score ≤2. Endoscopic improvement required a Mayo endoscopic subscore of 0–1 with ≥1-point improvement. Data on maintenance therapy in responders and treatment-related complications were collected. The study was approved by the local Bioethics Committee. Results Twenty-nine eligible patients treated across 10 Polish gastroenterology centers between 2021 and 2025 were identified (20 males, 9 females; median age 33 years, range 19–54). Indications for liver transplantation included primary sclerosing cholangitis (PSC; 19 patients, with recurrent PSC diagnosed in 9), overlapping autoimmune hepatitis/PSC (AIH/PSC; 7 patients), and AIH (3 patients). The median interval since LT was 6 years (range 1–14), and the median duration of UC was 10 years (range 3–22); extensive UC was present in 23 patients. The median follow-up period was 9 months (range 1–47). At week 14, 24 patients (83%) achieved a clinical response and proceeded to intravenous or subcutaneous maintenance therapy. Clinical remission occurred in 6 patients (21%), and endoscopic improvement in 13 (45%). At the time of analysis, 14 patients (48%) remained on vedolizumab. Severe complications were the main reasons for discontinuation in 10 responders, including intestinal lymphoma (n = 1), colonic dysplasia (n = 1), cholangitis (n = 2), Epstein–Barr virus infection (n = 1), and Clostridioides difficile infection (n = 1). One patient experienced secondary loss of response; in two, infusion intervals were shortened for symptom worsening. Two patients stopped treatment voluntarily, and one died after a second LT. One patient had an uncomplicated pregnancy while continuing subcutaneous vedolizumab. Conclusion The 14-week clinical response rate to vedolizumab in UC patients after LT was high, with nearly half achieving endoscopic improvement. However, the modest remission rate indicates that longer treatment may be necessary to reach optimal targets in this population. Close surveillance remains crucial for early detection of UC/PSC-related and treatment-associated complications. Conflict of interest: Kucha, Piotr: Other: Support for attending meetings or travel from Takeda Zaborowska, Marta: Travel grant from Abbvie and Pfizer Wypych, Joanna: Received lecture fees, consultancy fees, or travel educational grants from Takeda, Eli Lilly, Abbvie, Recordati Augustyn, Monika: No conflict of interest Brodowski, Tomasz: No conflict of interest Eder, Piotr Michał: Travel and educational grants: Takeda, Ferring, Abbvie, Janssen (J&J), Eli Lilly. Lecture and/or consultancy fees: Takeda, Abbvie, Ferring, Janssen (J&J), Eli Lilly, Bristol Myers Squibb, Pfizer, Recordati, Ibsen, Sandoz. Filip, Rafal: No confict of interest to declare Gawron-Kiszka, Magdalena: Lecture fees and/or travel grants from AbbVie, Eli Lilly, Ferring, Janssen, Pfizer, Recordati, Sobi, Takeda Kaniewska, Magdalena: to be Koza, Jarosław: No conflict of interest Kłosowska-Kapica, Krystyna: No conflict of interest Maciejewska, Katarzyna: Received lecture fees, consultancy fees, or travel educational grants from Takeda, Abbvie, Eli Lilly, SOBI Zagórowicz, Edyta Sylwia: Honoraria for lectures: J&J, Takeda, Abbvie, Lilly. Advisory boards: J&J, Lilly. Travel grants: Takeda.
Kucha et al. (Thu,) studied this question.