title: Risk of colonic neoplasia after liver transplantation for primary sclerosing cholangitis.
abstract: BACKGROUND
  Primary sclerosing cholangitis (PSC) confers an increased risk of colon cancer in patients with inflammatory bowel disease (IBD). However, there is a scarcity of data to determine whether the rate of colon cancer changes after liver transplantation (LT) in IBD patients with PSC. The aims were 1) to estimate the risk of colon neoplasia after LT in IBD patients with PSC; 2) to identify the factors associated with colon neoplasia after LT in IBD patients with PSC.
  
  
  METHODS
  We identified patients with IBD/PSC who underwent LT from 1998-2005 (n = 43). Two control groups were identified. Control 1 was IBD/PSC who did not undergo LT, matched 1:1 for age, gender, and type of IBD. Control 2 was patients with chronic liver disease other than PSC who underwent LT, matched 1:1 for age, gender, and follow-up time since LT. All patients were monitored by serial colonoscopy. Logistic regression analysis was used.
  
  
  RESULTS
  During a mean follow-up of 54.7 ± 47.7 months, patients with IBD/PSC who underwent LT had similar rate of colon neoplasia compared to those who did not have LT (34% versus 30%, P = 0.24). The rate of colon neoplasia in LT recipients was higher in PSC patients compared to those with other forms of chronic liver disease (34% versus 0%, P = 0.018). Post-LT cytomegalovirus infection was associated with higher likelihood of colon neoplasia post-LT in IBD/PSC patients (hazard ratio = 4.4, P = 0.024). There was no significant difference in survival outcome between the three study groups.
  
  
  CONCLUSIONS
  IBD/PSC patients remain at an increased risk of colon neoplasia after LT.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Hanouneh
authors.forename: Carole
authors.initials: C
authors.lastname: Macaron
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Zein
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003110:Colonic Neoplasms / Q000209:etiology* / Q000821:virology; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012306:Risk; D015996:Survival Rate