title: Colorectal cancer in patients with inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis.
abstract: BACKGROUND
  Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) may have an increased risk of developing colorectal cancer (CRC) after liver transplantation (LT). We evaluated our patients with PSC after LT to identify risk factors for CRC and its impact on survival.
  
  
  METHODS
  A total of 152 patients (108 men, 100 with IBD) with PSC who underwent 173 LTs between 1986 and May 2000 were analyzed in three groups: (1) PSC without IBD (n=52); (2) PSC with colectomy (pre-LT and at LT) (n=17, colectomy pre-LT in 13 and simultaneous colectomy at LT in four); and (3) PSC with IBD and an intact colon (n=83). The following factors were studied: age, gender, liver, and renal biochemistry, international normalized ratio, Child-Pugh stage, operative time, blood use, hospital stay, immunosuppression, risk of CRC, retransplantation rate, and mortality.
  
  
  RESULTS
  The incidence of CRC after LT was 5.3% (8/152) compared with 0.6% (7/1,184) in non-PSC cases (P<0.001). All CRCs in the PSC group were in patients with IBD and an intact colon. The cumulative risk of developing CRC in the 83 patients with an intact colon and IBD was 14% and 17% after 5 and 10 years, respectively (PSC non-IBD group 0% risk after 10 years, P<0.06). The multivariate analysis showed three significant variables related to the risk of developing CRC: colonic dysplasia after LT (P<0.0003), duration of colitis more than 10 years (P<0.002), and pancolitis (P<0.004). The cause of death in patients with CRC was cancer related in 75% of cases with a reduced 5-year survival of 55% versus 75% without CRC (not significant).
  
  
  CONCLUSIONS
  Patients with PSC undergoing LT with a long history of ulcerative colitis and pancolitis have an increased risk of developing CRC with reduced survival. We advocate long-term aggressive colonic surveillance and colectomy in selected high-risk patients with longstanding severe colitis.
authors.affiliation: Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, England, United Kingdom.
authors.forename: Alonso
authors.initials: A
authors.lastname: Vera
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Val
authors.initials: V
authors.lastname: Ussatoff
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Simon
authors.initials: S
authors.lastname: Radley
authors.forename: A  David
authors.initials: A
authors.lastname: Mayer
authors.forename: John A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: Paul
authors.initials: P
authors.lastname: McMaster
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D003082:Colectomy; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors