Risk of Colorectal Carcinoma in Post-Liver Transplant Patients
Risk of Colorectal Carcinoma in Post-Liver Transplant Patients
Liver transplant patients (LTx) have an increased risk for developing de novo malignancies, but for colorectal cancer (CRC) this risk is less clear. We aimed to determine whether the CRC risk post-LTx was increased. A systematic search was performed in MEDLINE and Cochrane databases to identify studies published between 1986 and 2008 reporting on the risk of CRC post-LTx. The outcomes were (1) CRC incidence rate (IR per 100 000 person-years (PY)) compared to a weighted age-matched control population using SEER and (2) relative risk (RR) for CRC compared to the general population. If no RR data were available, the RR was estimated using SEER. Twenty-nine studies were included. The overall post-LTx IR was 119 (95% CI 88–161) per 100 000 PY. The overall RR was 2.6 (95% CI 1.7–4.1). The non-primary sclerosing cholangitis (PSC) IR was 129 per 100 000 PY (95% CI 81–207). Compared to SEER (71 per 100 000 PY), the non-PSC RR was 1.8 (95% CI 1.1–2.9). In conclusion, the overall transplants and the subgroup non-PSC transplants have an increased CRC risk compared to the general population. However, in contrast to PSC, non-PSC transplants do not need an intensified screening strategy compared to the general population until a prospective study further defines recommendations.
Liver transplantation (LTx) patients are at an increased risk of developing a variety of cancers, especially skin malignancies and lymphomas. Reports published in the last decade have however shown conflicting results with respect to the colorectal cancer (CRC) risk after LTx. Two studies suggested no increased risk for CRC post-LTx. However, a Dutch cohort study reported a relative risk (RR) of 12.5 (95% CI 2.5–36.6) for CRC in post-LTx patients compared to an age-matched general population. Furthermore, a study from the University of Cincinnati reported a lower age of onset of CRC after LTx and a decreased 5-year survival compared with the general population.
A markedly increased risk of CRC is well established in patients with primary sclerosing cholangitis (PSC) with associated ulcerative colitis (UC). These patients even have an increased CRC risk compared to patients with UC alone, which itself is a known risk factor for the development of CRC. Given this increased risk, special guidelines exist for surveillance colonoscopy in PSC patients irrespective of LTx.
Currently, there are no conclusive recommendations for CRC screening in non-PSC post-LTx patients. This meta-analysis, therefore, aimed to determine whether the relative risk (RR) and incidence rate (IR) of CRC are increased in post-LTx patients in general, and specifically in non-PSC post-LTx patients, compared to the general population.
Abstract and Introduction
Abstract
Liver transplant patients (LTx) have an increased risk for developing de novo malignancies, but for colorectal cancer (CRC) this risk is less clear. We aimed to determine whether the CRC risk post-LTx was increased. A systematic search was performed in MEDLINE and Cochrane databases to identify studies published between 1986 and 2008 reporting on the risk of CRC post-LTx. The outcomes were (1) CRC incidence rate (IR per 100 000 person-years (PY)) compared to a weighted age-matched control population using SEER and (2) relative risk (RR) for CRC compared to the general population. If no RR data were available, the RR was estimated using SEER. Twenty-nine studies were included. The overall post-LTx IR was 119 (95% CI 88–161) per 100 000 PY. The overall RR was 2.6 (95% CI 1.7–4.1). The non-primary sclerosing cholangitis (PSC) IR was 129 per 100 000 PY (95% CI 81–207). Compared to SEER (71 per 100 000 PY), the non-PSC RR was 1.8 (95% CI 1.1–2.9). In conclusion, the overall transplants and the subgroup non-PSC transplants have an increased CRC risk compared to the general population. However, in contrast to PSC, non-PSC transplants do not need an intensified screening strategy compared to the general population until a prospective study further defines recommendations.
Introduction
Liver transplantation (LTx) patients are at an increased risk of developing a variety of cancers, especially skin malignancies and lymphomas. Reports published in the last decade have however shown conflicting results with respect to the colorectal cancer (CRC) risk after LTx. Two studies suggested no increased risk for CRC post-LTx. However, a Dutch cohort study reported a relative risk (RR) of 12.5 (95% CI 2.5–36.6) for CRC in post-LTx patients compared to an age-matched general population. Furthermore, a study from the University of Cincinnati reported a lower age of onset of CRC after LTx and a decreased 5-year survival compared with the general population.
A markedly increased risk of CRC is well established in patients with primary sclerosing cholangitis (PSC) with associated ulcerative colitis (UC). These patients even have an increased CRC risk compared to patients with UC alone, which itself is a known risk factor for the development of CRC. Given this increased risk, special guidelines exist for surveillance colonoscopy in PSC patients irrespective of LTx.
Currently, there are no conclusive recommendations for CRC screening in non-PSC post-LTx patients. This meta-analysis, therefore, aimed to determine whether the relative risk (RR) and incidence rate (IR) of CRC are increased in post-LTx patients in general, and specifically in non-PSC post-LTx patients, compared to the general population.
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