Colorrectal Cancer and Liver Transplant

Abstract

Introduction: Liver transplantation recipients have an increased risk for developing de novo malignancies, because of the severe immunosuppression necessary to avoid acute and chronic rejections. Neoplasm in transplanted patients is one of the biggest problems recipients could get for the success of the transplant process, so that we must analyze it carefully. A variety of cancers are identified, especially skin cancers and lymphoproliferative disease. But the increased risk for colorectal cancer (CRC) is yet unclear. Methods: We analyze a total of 1500 patients who underwent liver transplantion from April 1986 to April 2011. Of all those patients, 15 of them (1%) were diagnosed of CRC during their evolution. Results: 73.4% of the recipients who has been diagnosed of CRC are men. Enolism is the most common cause of liver transplantation in these patients (26.6%). The mean age at diagnosis was 59.25 years (± 8.5). The average time between transplantation and diagnosis of CRC was 5.3 years (± 5.97). The 69.2% of CRC are located on the left colon, and 26.7% of them were located in the rectum. Surgery was performed in 100% of cases and with curative intention in 86.6%. 54.5% of tumors are well differentiated. 45.6% of CRC are diagnosed in early stages (Stages I and II of the AJCC/TNM). 33.3% of the cases develop colonic polyps during follow-up. Almost 100% oftumors showed microsatellite stability (MS). Recipient's overall survival and recipient's survival without disease recurrence was 70 months (± 40.47) and 55.6 months (± 39.24) respectively. Conclusions: CRC in liver transplant patients has clinical and anatomic characteristics similar to those who appear in general population. The location is also similar. However, they could have an aggressive behavior, probably due to immunosuppression. Prolonged immunosuppression encourages the development of tumors in these patients. However there are patients in our series diagnosed with CRC, only a year after transplantation, which would suggest the need to study more closely pretransplant candidates on the waiting list.