Increased risk of colorectal polyps in patients with non-alcoholic fatty liver disease undergoing liver transplant evaluation.
BACKGROUND
Screening colonoscopy is a standard part of the liver transplant (LT) evaluation process. We aimed to evaluate the yield of screening colonoscopy and determine whether non-alcoholic fatty liver disease (NAFLD) was associated with an increased risk of colorectal neoplasia.


METHODS
We retrospectively assessed all patients who completed LT evaluation at our center between 1/2008-12/2012. Patients <50 years old and those without records of screening colonoscopy, or with greater than average colon cancer risk were excluded.


RESULTS
A total of 1,102 patients were evaluated, 591 met inclusion criteria and were analyzed. The mean age was 60 years, 67% were male, 12% had NAFLD and 88% had other forms of chronic liver disease. Overall, 42% of patients had a polyp found on colonoscopy: 23% with adenomas, 14% with hyperplastic polyps and with 1% inflammatory polyps. In the final multivariable model controlling for age, NAFLD [odds ratio (OR) 2.41, P=0.001] and a history of significant alcohol use (OR 1.69, P=0.004) were predictive of finding a polyp on colonoscopy. In addition, NAFLD (OR 1.95, P=0.02), significant alcohol use (OR 1.70, P=0.01) and CTP class C (OR 0.57, P=0.02) were associated with adenoma, controlling for age.


CONCLUSIONS
Screening colonoscopy in patients awaiting LT yields a high rate of polyp (43%) and adenoma (22%) detection, perhaps preventing the accelerated progression to carcinoma that can occur in immunosuppressed post-LT patients. Patients with NAFLD may be at a ~2 fold higher risk of adenomas and should be carefully evaluated prior to LT.
Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Birju D
BD
Bhatt
Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Thresiamma
T
Lukose
Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Abby B
AB
Siegel
Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Robert S
RS
Brown
Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Elizabeth C
EC
Verna
Colon cancer; cirrhosis; liver transplant (LT); non-alcoholic fatty liver disease (NAFLD); screening