Does liver transplant increase risk for colorectal cancer?

Takeaway

• Liver transplant (LT) was not associated with increased risk of colorectal cancer (CRC).
• LT patients with primary sclerosing cholangitis (PSC) or ulcerative colitis (UC) had 7-fold increased risk of CRC vs the general UK population.

Why this matters

• Malignancies are the second most common cause of death in transplant recipients.
• Long-term post-LT screening may be advisable for PSC/UC patients.

Key results

• Crude incidence rate of CRC after LT patients was 8.2 per 10,000 person-years (PYs) of follow-up.
• Standardized incidence ratios (SIR) in the LT vs general UK population was 0.92.
• Among patients without UC or PSC, incidence was 4.3/10,000 PYs (SIR vs general population 0.46; 95% CI 0.30-0.67).
• Among patients with either UC or PSC, incidence was 53.0/10,000 PYs.
• Rate of CRC among UC/PSC patients was 12.3 times higher than in those without UC or PSC (95% CI= 7.20-21.4) and 7-times higher than the general UK population (95% CI 4.71-10.04).
• SIR among participants with UC was 10.90 (95% CI 7.08-16.10).
• In patients with either UC or PSC, median survival from cancer diagnosis was 4.7 (95% CI 2.1-8.0) yrs.
• 1-, 5-, and 10-yr survival rates from CRC diagnosis were 81%, 59% and 47% in patients with either UC or PSC.
• In participants without UC or PSC, median survival was 3.1 (95% CI 0.7-6.4) yrs.
• 1- and 5-yr survival was 60% and 37%.
• In the UC population, median survival time was 8 yrs.
• 1-, 5-, and 10-yr survival was 82%, 61%, and 46%.

Study design

• Retrospective study of 8115 adult patients undergoing LT at 6 UK units between 1 January 1990 and 31 December 2010.
• Funding: Royal Free Charity.

Limitations

• Incomplete data for LT indication and CRC characteristics.
• Heterogeneity of post-LT colonoscopy policies between units.