Alcoholic liver disease is a strong predictor of colorectal polyps in liver transplant recipients

Abstract

Background and aims Colorectal cancer (CRC) is associated with a significantly reduced survival rate in transplant recipients. The prevalence and risk factors of CRC and of colorectal polyps after orthotopic liver transplant (OLT) remain unclear. The study aim was to determine the prevalence of colorectal polyps in OLT recipients. A secondary objective was to explore possible risk factors of polyps.

Patients and materials This was a retrospective single center study of all OLT recipients transplanted between 2007 and 2009. All patients who underwent a colonoscopy 5 ± 5 years after OLT were included. The outcome was colorectal polyps, as identified on colonoscopy. A logistic regression model was performed to identify potential predictors of polyps.

Results Of 164 OLT recipients, 80 were included in this study. Polyps were diagnosed in 37 % of patients before transplant and in 33 % afterwards. With regard to post-transplant lesions, 22 % were advanced adenomas or cancerous. In the regression analysis, the odds of post-transplant polyps were 11 times higher in patients with alcoholic liver disease (OR 11.3, 95 %CI 3.2 – 39.4; P < 0.001).

Conclusion Patients with end-stage liver disease may be at high risk of colorectal polyps before and after liver transplant, and screening should be continued in both contexts. Those with alcoholic liver disease are particularly at risk for post-OLT polyps and may benefit from more intensive screening.

• References

• 1 Pruthi J, Medkiff K, Esrason K. et al. Analysis of causes of death in liver transplant recipients who survived more than 3 years. Liver Transpl 2001; 7: 811-815
• 2 Park H, Hwang S, Ahn C. et al. De novo malignancies after liver transplantation: incidence comparison with the Korean cancer registry. Transplant Proc 2012; 44: 802-805
• 3 Herrero J, Alegre F, Quiroga J. et al. Usefulness of a program of neoplasia surveillance in liver transplantation. A preliminary report. Clin Transplant 2009; 23: 532-536
• 4 Martin HL, Chen JW, Koczwara B. Cancer in liver transplant recipients: Management and outcomes. Asia Pac J Clin Oncol 2013; 9: 257-264
• 5 Chak E, Saab S. Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review. Liver Int 2010; 30: 1247-1258
• 6 Johnson E, Leverson G, Pirsch J. et al. A 30-year analysis of colorectal adenocarcinoma in transplant recipients and proposal for altered screening. J Gastrointest Surg 2007; 11: 272-279
• 7 Buell J, Papaconstantinou H, Skalow B. et al. De novo colorectal cancer: five-year survival is markedly lower in transplant recipients compared with the general population. Transplant Proc 2005; 37: 960-961
• 8 Leslie A, Carey F, Pratt N. et al. The colorectal adenoma-carcinoma sequence. Br J Surg 2002; 89: 845-860
• 9 Bhatt B, Lukose T, Siegel A. et al. Increased risk of colorectal polyps in patients with non-alcoholic fatty liver disease undergoing liver transplant evaluation. J Gastrointest Oncol 2015; 6: 459-468
• 10 Zaman A, Hapke R, Flora K. et al. Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol 1999; 94: 895-899
• 11 Lucey M, Terrault N, Ojo L. et al. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19: 3-26
• 12 European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2016; 64: 433-485
• 13 Singh S, Edakkanambeth Varayil J, Loftus E. et al. Incidence of colorectal cancer after liver transplantation for primary sclerosing cholangitis: a systematic review and meta-analysis. Liver Transpl 2013; 19: 1361-1369
• 14 Sint Nicolaas J, de Jonge V, Steyerberg E. et al. Risk of colorectal carcinoma in post-liver transplant patients: a systematic review and meta-analysis. Am J Transplant 2010; 10: 868-876
• 15 Singal AG, Gupta S, Lee J. et al. Importance of determining indication for colonoscopy: implications for practice and policy. Clin Gastroenterol Hepatol 2014; 12: 1958-1963 .e1-3
• 16 Cotton P, Williams C, Hawes R. et al. Practical gastrointestinal endoscopy: the fundamentals. Wiley; 2011
• 17 Anderson JC, Butterly LF, Goodrich M. et al. Differences in detection rates of adenomas and serrated polyps in screening versus surveillance colonoscopies, based on the new hampshire colonoscopy registry. Clin Gastroenterol Hepatol 2013; 11: 1308-1312
• 18 Lieberman D, de Garmo P, Fleischer D. et al. Colonic neoplasia in patients with nonspecific GI symptoms. Gastrointest Endosc 2000; 51: 647-651
• 19 Albright J, Bonatti H, Stauffer J. et al. Colorectal and anal neoplasms following liver transplantation. Colorectal Dis 2010; 12: 657-666
• 20 Rudraraju M, Osowo A, Singh V. et al. Do patients need more frequent colonoscopic surveillance after liver transplantation?. Transplant Proc 2008; 40: 1522-1524
• 21 Dunn GP, Bruce AT, Ikeda H. et al. Cancer immunoediting: from immunosurveillance to tumor escape. Nat Immunol 2002; 3: 991-998
• 22 Selgrad M, Koornstra J, Fini L. et al. JC virus infection in colorectal neoplasia that develops after liver transplantation. Clin Cancer Res 2008; 14: 6717-6721
• 23 Park J, Choi M, Kim S. et al. Increased incidence of colorectal malignancies in renal transplant recipients: a case control study. Am J Transplant 2010; 10: 2043-2050
• 24 Kwak E, Julian K. Human papillomavirus infection in solid organ transplant recipients. Am J Transplant 2009; 9: S151-S160
• 25 Jeschek P, Ferlitsch A, Salzl P. et al. A greater proportion of liver transplant candidates have colorectal neoplasia than in the healthy screening population. Clin Gastroenterol Hepatol 2015; 13: 956-962
• 26 Zhou J, Hu Z, Zhang Q. et al. Spectrum of de novo cancers and predictors in liver transplantation: analysis of the Scientific Registry of Transplant Recipients Database. PLoS ONE 2016; 11: e0155179
• 27 Ben Q, Wang L, Liu J. et al. Alcohol drinking and the risk of colorectal adenoma: a dose-response meta-analysis. Eur J Cancer Prev 2015; 24: 286-295
• 28 Bardou M, Montembault S, Giraud V. et al. Excessive alcohol consumption favours high risk polyp or colorectal cancer occurrence among patients with adenomas: a case control study. Gut 2002; 50: 38-42
• 29 Lieberman D, Prindiville S, Weiss D. et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290: 2959-2967
• 30 Oyesanmi O, Snyder D, Sullivan N. et al. Alcohol consumption and cancer risk: understanding possible causal mechanisms for breast and colorectal cancers. Evid Rep Technol Assess (Full Rep) 2010; 1-151
• 31 Pronko P, Bardina L, Satanovskaya V. et al. Effect of chronic alcohol consumption on the ethanol- and acetaldehyde-metabolizing systems in the rat gastrointestinal tract. Alcohol Alcohol 2002; 37: 229-235
• 32 Basuroy S, Sheth P, Mansbach C. et al. Acetaldehyde disrupts tight junctions and adherens junctions in human colonic mucosa: protection by EGF and L-glutamine. Am J Physiol Gastrointest Liver Physiol 2005; 289: G367-G375
• 33 Simanowski U, Suter P, Russell R. et al. Enhancement of ethanol induced rectal mucosal hyper regeneration with age in F344 rats. Gut 1994; 35: 1102-1106
• 34 Morita M, Tabata S, Tajima O. et al. Genetic polymorphisms of CYP2E1 and risk of colorectal adenomas in the Self Defense Forces Health Study. Cancer Epidemiol Biomarkers Prev 2008; 17: 1800-1807
• 35 Doubeni C, Weinmann S, Adams K. et al. Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Intern Med 2013; 158: 312-320