Liver Transplantation May Reduce Colorectal Neoplasia Risk

TOPLINE:

In patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), liver transplantation was associated with a 34% reduction in the risk for colorectal neoplasia. However, 21% of transplant recipients still developed neoplasia.

METHODOLOGY:

• PSC affects 4%-8% of patients with IBD, increasing their risk for colorectal neoplasia. About 40% of patients with PSC undergo liver transplantation, but the post-transplantation risk for colorectal neoplasia remains understudied.
• Researchers conducted a retrospective cohort study of patients with PSC and IBD from two sites in the United States, comparing outcomes between those who underwent liver transplantation with matched control patients who did not.
• All transplant recipients had at least one colonoscopy after the procedure.
• The primary outcome was the development of colorectal neoplasia, including colorectal cancer, low-grade dysplasia, or high-grade dysplasia.

TAKEAWAY:

• The cohort included 979 patients (66% men; 83% with ulcerative colitis), of whom 320 underwent liver transplant and 659 served as control individuals; the mean age at IBD diagnosis was 32 years, at PSC diagnosis was 39 years, and at end of follow-up was 50 years.
• During follow-up, 21% of transplant recipients developed colorectal neoplasia compared with 26% of control individuals who did not undergo transplantation (P = .086).
• Liver transplantation was associated with a 34% reduced risk for colorectal neoplasia and a 44% reduced risk for both low- and high-grade dysplasia.
• Recurrent PSC in the transplanted liver was more prevalent in patients who developed neoplasia than those who did not (54% vs 38%; P = .017).
• Other predictors of dysplasia or cancer risk included older age (adjusted odds ratio [aOR], 1.02), diagnosis of ulcerative colitis vs Crohn’s disease (aOR, 1.63), and histologic activity (aOR, 1.61).
• Undergoing chromoendoscopy at least once was associated with a higher likelihood of developing colorectal neoplasia (aOR, 1.71).

IN PRACTICE:

“Careful profiling of PSC-IBD patients before and after [liver transplantation] offers an important opportunity to define the mechanism(s) of IBD-associated [colorectal neoplasia] in patients with PSC-IBD. This may also have broader implications for prevention of IBD-associated colon neoplasia,” the authors wrote.

SOURCE:

The study, led by Nayantara Coelho-Prabhu, MBBS, Mayo Clinic School of Medicine, Rochester, Minnesota, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The data were primarily derived from referral centers, possibly leading to an overrepresentation of patients with more severe disease. The study did not assess the cumulative burden of endoscopic and histologic activity over the entire course of IBD. The lack of information on the type of immunosuppression used post-transplantation may also affect the findings.

DISCLOSURES:

One author received grants from the National Institutes of Health (NIH), Leona M. and Harry B. Helmsley Charitable Trust, and the Chleck Family Foundation. Another author received a separate NIH grant. One author served on a scientific advisory board for Geneoscopy.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.