Over the past 20 years, the number of solid organ transplants (SOT) for a variety of indications has been on the rise. Consequently, more patients with inflammatory bowel diseases (IBD) are also receiving SOT. Although SOT related immunosuppression may at times control IBD related inflammation, many patients still require additional immunosuppressive medications for control of their IBD. With the growing therapeutic armamentarium for IBD, physicians are in search for guidance on the safety of using additional immunosuppressive medications in patients who are already receiving transplant related immunosuppressive medications.