Do patients need more frequent colonoscopic surveillance after liver transplantation?

Solid-organ transplant recipients are at higher risk for developing malignancies believed to be due to the use of immunosuppression. The aim of our study was to determine the risk of development of colon polyps with advanced features and colon carcinoma in liver transplant (LT) recipients when compared to individuals with chronic liver disease (CLD) and individuals without liver disease.

Case-control analyses of 82 LT recipients who underwent posttransplant colonoscopy, matched for age, gender, and year of colonoscopy, were compared to 82 patients with chronic liver disease and 82 patients without liver disease undergoing screening colonoscopy. Incidence of advanced adenomas (polyps >1 cm, high-grade dysplasia, villous histology) and colon carcinoma was documented.

The groups were similar in age and gender, but there were more Hispanic patients in the LT group. Six patients (7.3%) of the LT group, 3 patients (3.6%) of the chronic liver disease group, and 1 patient (1.2%) of the no-liver-disease group had the outcome of interest, but the P value was not significant. Immunosuppression used was tacrolimus and mycophenolate in 2 patients, tacrolimus-only in 2 patients, and cyclosporine in 2 patients.

There is a trend toward increased incidence of advanced colon polyps and colon carcinoma in immunosuppressed patients after liver transplantation. Larger studies are needed to determine whether posttransplant colon cancer surveillance should be more frequent than currently recommended for nontransplant patients.