Comparative Perianal Fistula Closure Rates Following Autologous Adipose Tissue-derived Stem Cell Transplantation or Treatment with Anti-tumor Necrosis Factor Agents After Seton Placement in Patients with Crohn's Disease: a Retrospective...

Overview

Journal Stem Cell Res Ther

Publisher Biomed Central

Date 2021 Jul 14

PMID 34256838

Citations 6

Authors

Min Young Park

Yong Sik Yoon

Jong Lyul Lee

Sang Hyoung Park

Byong Duk Ye

Suk-Kyun Yang

Chang Sik Yu

Affiliations

Soon will be listed here.

Abstract

Background: Perianal fistula is one of the most common complications in Crohn's disease, and various medical and surgical treatments are being tried. The aim of this study was to compare the perianal fistula closure rates following treatment with anti-tumor necrosis factor (TNF) agents or autologous adipose tissue-derived stem cell (auto-ASC) transplantation with Crohn's disease (CD).

Methods: CD patients who underwent seton placement for perianal fistula from January 2015 to December 2019 at a tertiary referral center were retrospectively reviewed. Patients were divided into two groups, one that received sequential treatments with anti-TNF agents (anti-TNF group) and the other that underwent auto-ASC transplantation (stem cell group). Clinical variables and fistula closure rates were compared in the two groups.

Results: Of the 69 patients analyzed, 39 were treated with anti-TNF agents and 30 underwent auto-ASC transplantation. Compared with the stem cell group, patients in the anti-TNF group were older (p=0.028), were more frequently male (p=0.019), had fistulas with more penetrating behavior (p=0.002), had undergone surgery more frequently (p=0.010), and had a shorter interval from seton placement to intended treatment (p<0.001). During a median follow-up of 46 months (range, 30-52.5 months), fistula closure rates were significantly faster (83.3% vs. 23.1%, p<0.001), and the mean interval from seton placement to fistula closure significantly shorter (14 vs. 37 months, p<0.001) in the stem cell than in the anti-TNF group. Three patients experienced fistula recurrence, all in the stem cell group.

Conclusions: Medical treatment using anti-TNF agents and auto-ASC transplantation are feasible treatment options after seton placement for Crohn's perianal fistula. However, the closure rate was significantly faster and the time to closure significantly shorter in patients who underwent auto-ASC transplantation than medical treatment.

Trial Registration: This study was retrospectively registered and approved by the Institutional Review Board of Asan Medical Center, number 2020-1059 .

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