Feasibility and findings of colonoscopy for living-donor liver transplant candidates.
OBJECTIVE
Living-donor liver transplantation (LDLT) has been widely performed in patients with end-stage liver disease and hepatocellular carcinoma in Japan. Although extrahepatic cancer survey for LDLT candidates is absolutely required, few reports have indicated the optimal surveillance method for colorectal cancer. The aim of this study is to investigate the feasibility and findings of colonoscopy before LDLT.


METHODS
From January 2004 to August 2006, we prospectively enrolled all of the scheduled LDLT candidates of our hospital for pretransplant colonoscopy examination.


RESULTS
A total of 81 patients were enrolled for colonoscopy. Of these patients, 67 (83%) could actually undergo colonoscopy. Patients who could not undergo colonoscopy exhibited more impaired liver function than those who could (median Model End-Stage Liver Disease score; 25.5 vs. 14.5, P=0.0003). Among patients who underwent colonoscopy, observation of total colon was attained in 64 (96%). Neoplasia was found in 28 (42%) patients, including 4 patients with adenomas > or =10 mm, 1 patient with adenomas with high-grade dysplasia, and 3 patients with invasive cancer. Patients who had advanced neoplasia (adenoma > or =10 mm, adenomas with high-grade dysplasia, or invasive cancer) were likely to have a lower performance status (PS) (7/8 were PS 3) than those who did not (P=0.054).


CONCLUSIONS
Clinically significant tumors were found in a considerable portion of LDLT candidates, particularly in lower PS patients. Because immunosuppressive agents after transplantation may worsen malignant tumors, colonoscopy before transplantation is recommended in patients who can tolerate the procedure.
Ishikawa
Shin
S
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kato
Jun
J
Kuriyama
Motoaki
M
Takemoto
Koji
K
Uraoka
Toshio
T
Takaki
Akinobu
A
Yagi
Takahito
T
Sakaguchi
Kohsaku
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult