Screening and Surveillance for Colorectal Cancer Before and After Heart Transplantation

Solid organ transplantation is associated with an increased risk of de novo malignancy due to immunosuppression. However, colorectal cancer (CRC) screening guidelines for heart transplantation (HT) candidates and recipients are the same as for the general population. We aimed to evaluate CRC screening practices among HT recipients both before and after HT.

We conducted a retrospective cohort study of adult HT recipients between 2013 and 2023 at a large volume transplant center. Patient-level data were collected, including demographics, laboratory studies, and use of pre-HT mechanical circulatory support (MCS); additionally, electronic medical records were reviewed to identify methods of CRC screening and surveillance. Guideline consensus recommendations were used to determine if patients were up-to-date with screening. The date of last follow-up was October 2024. Multivariable logistic regression was used to assess predictors of colonoscopy use for screening pre- and post-HT.

Between 2013 and 2023, 650 patients underwent HT. A total of 436 (67.1%) were of the recommended age for CRC screening, and 386 (88.5%) underwent CRC screening pre-HT. Fifty (13%) screened patients had high-risk features for CRC. Colonoscopy was utilized in 342 (88.6%) cases. The use of CT colonography was more frequent in those on MCS or inotropic support at the time of screening (32.9% vs. 6.6%, p < 0.00001). The use of temporary MCS was associated with lower odds of screening with colonoscopy (aOR 0.05, 95% CI 0.020.14, p < 0.0001). Adenomatous polyps were found on 91 (26.6%) pre-HT colonoscopies, and CRC was diagnosed in one HT recipient on pretransplant screening. A total of 330 (50.8%) patients were due for colonoscopy post-HT, of whom 171 (51.8%) completed screening. Older patients had higher odds of undergoing colonoscopy post-HT (aOR 1.06, 95% CI 1.02-1.1, p = 0.001). Adenomatous polyps were found on 33 (19.3%) of post-HT colonoscopies, and the incidence of CRC post-HT was 1.2%.

Further studies should explore optimal screening guidelines in the pre- and posttransplant population.