Colorectal and anal neoplasms following liver transplantation.
OBJECTIVE
Liver transplantation (LT) is the treatment of choice for end-stage liver disease. The required immunosuppression increases the risk for developing malignancies. Some viruses play a crucial role. Data on neoplasms of the colon, rectum and anus in LT are limited.


METHODS
A retrospective evaluation of the incidence and clinical course of colorectal and anal malignancies and colonic polyps in a series of 467 consecutive LTs in 402 individuals between 1998 and 2001 was performed. Standard immunosuppression included Tacrolimus, Mycophenolic acid and steroids.


RESULTS
During a median follow up of 5.2 years, three colon adenocarcinomas, one EBV associated cecal posttransplant lymphoproliferative tumour and two HPV associated anal tumours were identified. Pre-LT colonoscopy was performed in 161 patients (40%), and of 153 evaluable individuals, 53 (34.9%) had polyps. Colonoscopy was performed in 186 patients (46.3%) median 14.8 (range 0.2-77.8) months post-LT and 55 (29.3%) had polyps. Post-LT adenomatous polyps were detected in 47.3% of patients with pre-LT polyps vs 6.7% of patients without pre-LT polyps (P < 0.001). Patients with alcoholic liver disease had a significantly higher rate of adenoma formation (50.0% vs 11.1%, P < 0.001). No patient died from colorectal/anal malignancy.


CONCLUSIONS
The incidence of metachronous and new polyp formation in our study is similar to people who are not immunocompromised, but subgroups are at increased risk. Viral-associated malignancies, including post-transplant lymphoproliferative disorders and anal cancer, are important entities in the LT population suggesting that complete screening of the colon, rectum and anus including pre-LT and post-LT colonoscopy should be utilized.
Albright
J B
JB
Department of Surgery, South Bay Medical Center, Harbor City, California, USA.
Bonatti
H
H
Stauffer
J
J
Dickson
R C
RC
Nguyen
J
J
Harnois
D
D
Jeanpierre
C
C
Hinder
R
R
Steers
J
J
Chua
H
H
Aranda-Michel
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003113:Colonoscopy; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D015994:Incidence; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult