Screening Colonoscopy Should Be Required Prior to Kidney Transplant.

Abstract

Background: General health preventive screenings, including colonoscopy, can delay listing for kidney transplant. Unfortunately, length of time on dialysis has been correlated with allograft failure in transplant recipients. Many patients are reluctant to complete colonoscopy, despite its effectiveness in prevention of colon cancer by removal of adenomatous polyps. Methods: With IRB approval, we performed a retrospective analysis of 205 ESRD patients undergoing kidney transplant evaluation at University Hospitals Case Medical Center between 2010 and 2011. Patients age<48, with no colonoscopy on record, or with a personal history of colorectal cancer were excluded. Patients were stratified based on normal pathology at colonoscopy (no finding or hyperplastic polyp) or abnormal pathology at colonoscopy (adenomatous polyp or carcinoma). Results: 128 (62.4%) patients had normal colonoscopies and 77 (37.6%) patients had abnormal colonoscopies, with a median age of 59 (49-76) and 62 (50-73), respectively. Colonoscopic findings included 133 polyps total, 1 of which displayed high-grade dysplasia. A t-test returned seven variables with p≤0.20, on which a logistic regression analysis was performed. Significant findings included age>60 (OR=1.991, 95% CI: 1.077 to 3.678, p=0.028), as well as a higher BMI (OR=1.069, 95% CI: 1.011 to 1.131, p=0.020).Table: No Caption available.Conclusion: A large proportion of patients (38%) had polyps requiring removal. Quality colonoscopies should be obtained prior to transplant, especially for patients age>60 and for patients with higher BMIs.