title: Colorectal neoplasia in patients with primary sclerosing cholangitis undergoing liver transplantation: a Nordic multicenter study.
abstract: OBJECTIVE
  Several studies have implicated primary sclerosing cholangitis (PSC) as an additional risk factor for colorectal neoplasia in inflammatory bowel disease (IBD). Some reports have indicated that the risk is even higher in PSC-IBD patients after liver transplantation (Ltx), but this issue is controversial. We aimed to compare the risk of colorectal neoplasia in PSC-IBD patients before and after Ltx and to identify risk factors for colorectal neoplasia post-transplant.
  
  
  METHODS
  In a multicenter study within the Nordic Liver Transplant Group, we assessed the risk of colorectal neoplasia by using the competing risk regression analysis.
  
  
  RESULTS
  Among the 439 PSC patients included, 353 (80%) had IBD at the time of Ltx and 15 (3%) patients developed de novo IBD post-Ltx. The median duration of IBD was 15 (0-50) years at the time of Ltx and follow-up after Ltx was 5 (0-20) years. Ninety-one (25%) PSC-IBD patients developed colorectal neoplasia. The cumulative risk of colorectal neoplasia was higher after than before Ltx (HR: 1.9, 95% CI: 1.3-2.9, p = 0.002). A multivariate analysis demonstrated aminosalicylates and ursodeoxycholic acid as significantly associated with an increased risk of colorectal neoplasia post-Ltx. Duration and activity of IBD did not significantly affect the risk of neoplasia.
  
  
  CONCLUSIONS
  The even higher risk of colorectal neoplasia in PSC-IBD patients after when compared with that of before Ltx underscores the importance of regular surveillance colonoscopies post-Ltx. The association of aminosalicylates and ursodeoxycholic acid to the development of colorectal neoplasia after Ltx should be further investigated.
authors.affiliation: Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. kristin.kaasen.jorgensen@ous-hf.no
authors.forename: Kristin Kaasen
authors.initials: KK
authors.lastname: Jørgensen
authors.forename: Lina
authors.initials: L
authors.lastname: Lindström
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova
authors.forename: Maria
authors.initials: M
authors.lastname: Castedal
authors.forename: Styrbjörn
authors.initials: S
authors.lastname: Friman
authors.forename: Erik
authors.initials: E
authors.lastname: Schrumpf
authors.forename: Aksel
authors.initials: A
authors.lastname: Foss
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
authors.forename: Arno
authors.initials: A
authors.lastname: Nordin
authors.forename: Kathrine
authors.initials: K
authors.lastname: Holte
authors.forename: Allan
authors.initials: A
authors.lastname: Rasmussen
authors.forename: Annika
authors.initials: A
authors.lastname: Bergquist
authors.forename: Morten H
authors.initials: MH
authors.lastname: Vatn
authors.forename: Kirsten Muri
authors.initials: KM
authors.lastname: Boberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000636:Aminosalicylic Acids / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002756:Cholagogues and Choleretics / Q000009:adverse effects; D015209:Cholangitis, Sclerosing / Q000150:complications*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D011184:Postoperative Period; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D014580:Ursodeoxycholic Acid / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000636:Aminosalicylic Acids; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid