Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) may have an increased risk of developing colorectal cancer (CRC) after liver transplantation (LT).
In this study, a team of researchers from Birmingham, England, evaluated patients with PSC after LT to identify the risk factors for CRC, and its impact on patient survival.
The team assessed 152 patients (108 men, 100 with IBD) with PSC who underwent 173 LTs between 1986 and 2000.
They divided the patients into 3 groups:
- PSC without IBD (n = 52)
- PSC with colectomy (13 pre-LT and 4 at LT)
- PSC with IBD and an intact colon (n = 83).
The researchers assessed a number of factors, including age, gender, liver and renal biochemistry, international normalized ratio, Child-Pugh stage, operative time, blood use, hospital stay, immunosuppression, risk of CRC, retransplantation rate, and mortality.
|Cause of death in patients with colorectal cancer was cancer related in 75% of cases.|
The team found that the incidence of CRC after LT was 5% in patients with PSC, compared with 0.6% in non-PSC patients.
Furthermore, they determined that all CRCs in the PSC group were in patients with IBD and an intact colon. The cumulative risk of developing CRC in these patients was 14% after 5 years, and 17% after 10 years, compared to patients in the PSC group without IBD.
The team identified 3 variables related to the risk of developing CRC using multivariate analysis. These were colonic dysplasia after LT, duration of colitis more than 10 years, and pancolitis.
They found that the cause of death in patients with CRC was cancer related in 75% of cases.
Dr Alonso Vera's team concluded, "Patients with PSC undergoing LT with a long history of ulcerative colitis and pancolitis have an increased risk of developing CRC with reduced survival".
"We advocate long-term aggressive colonic surveillance and colectomy in selected high-risk patients with longstanding severe colitis".