RISK OF COLORECTAL NEOPLASIA IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS AND ULCERATIVE-COLITIS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Several centers have identified colorectal cancer in patients with pri mary sclerosing cholangitis (PSC) and ulcerative colitis (UC) who have undergone orthotopic liver transplantation. Increased frequency of su rveillance colonoscopy and prophylactic colectomy has been recommended , To address these concerns, we reviewed the posttransplantation exper ience with colorectal neoplasia in patients with PSC and UC at our ins titution. All patients with PSC and UC who underwent liver transplanta tion at Mayo Clinic between April 1985 and December 1993 were followed up through their complete history for colorectal dysplasia, cancer, o r death, Eighty-one of 108 patients with PSC (75%) had concomitant inf lammatory bowel disease (all but 1 had UC), Proctocolectomy had been p erformed before transplantation in 24 (30%). Median follow-up after tr ansplantation was 4.2 years. Among the 57 patients with intact colons, 3 developed colorectal cancer, an incidence of approximately 1% per p erson per year, The cumulative incidence of dysplasia was 15% at 5 yea rs and 21% at 8 years, Overall actuarial survival stratified by presen ce or absence of an intact colon at transplantation was similar (86% a nd 86%, respectively, at 5 years), The risk of carcinoma after transpl antation compared with that expected for patients during a comparable (pretransplantation) period was increased fourfold but was not statist ically significant. The risk of colorectal neoplasia (dysplasia and ca ncer) after liver transplantation in patients with PSC and UC is clini cally important, However, this risk had no impact on patient survival. Prophylactic proctocolectomy does not appear necessary, but annual su rveillance colonoscopy is recommended.