Progression to adenocarcinoma in Barrett's esophagus after liver transplantation

The risk for development of certain malignancies after transplantation is well known. Especially in premalignant lesions of the skin and colon, rapid progression is described. The aim of this study is to evaluate the progress of Barrett's mucosa to adenocarcinoma of the esophagus after liver transplantation.

Between 2000 and 2009, 895 patients underwent a liver transplantation in our department. All patients had an upper endoscopy as part of the evaluation before transplantation. Patients who had Barrett's mucosa described in their endoscopy report were identified. The records of these patients were retrospectively reviewed.

There were seven patients who had Barrett's mucosa in the preoperative endoscopy. Five of these patients (71%) developed an esophageal adenocarcinoma in a median time of 66 months after liver transplantation. One had stage II disease and four had stage III disease. Three of them underwent neoadjuvant therapy. All patients underwent an en bloc esophagectomy. One patient developed recurrent disease after 12 months and died 37 months after esophagectomy. The other four patients are still alive without recurrence and have a median survival of 16 months.

Esophageal cancer after liver transplantation is rare, whereas the risk for progression of Barrett's esophagus to adenocarcinoma is extremely high. Surveillance endoscopy with aggressive endoscopic treatment of the Barrett's is essential for these patients to prevent them from cancer death. Furthermore, immunosuppression therapy based on immunosuppressants with antitumoral effects should be preferred. The esophagectomy with neoadjuvant therapy is also in immunosuppressant patients feasible without increased risk for complications.