The Prevalence of Colorectal Adenoma in Solid Organ Transplant Recipients: A Case Control Study

Abstract

Purpose: It is not conclusively clear whether immunosuppression in solid organ recipients confers increased risk to the development of colorectal adenocarcinoma, which in most cases arise from colorectal adenomas. The aim of this study is to determine whether there is an increased prevalence of colorectal adenomas in solid organ transplant recipients compared to immunocompetent subjects. Methods: We conducted a retrospective study at a single inner city tertiary care center. Charts of 1092 patients who had undergone heart, liver and kidney transplants between 1995 and 2010 were reviewed. All individuals who had at least one completed colonoscopy following the transplant were included. We excluded those with history of colon cancer prior to the transplant, history of inflammatory bowel disease, history of HIV and incomplete records. One hundred and eighty two patients who met the criteria were enrolled. Demographic data, comorbidities and polyp description when present were collected. Similar information was collected on a control group of 71 individuals with no prior transplants. Results: A total of 182 transplant recipients underwent colonoscopy after their transplant (64% male, 64% black, Mean age 57±12, 74% were over 50 years of age). The adenoma detection rate in the transplant recipients was 21.4% compared to 25.4% in the control group (p=0.50). The adenoma detection rate among transplant recipients aged over 50 was 24.6%. Advanced adenomas were seen in 7.7% of study population compared to 7.0% in the control population. We found 4 (2.2%)carcinoma cases in the transplant group, there were no carcinomas found in the control group. The quality of bowel preparation was rated as good in 57% of the transplant population and 47% in the control group. Conclusion: We did not find any significant statistical difference in the detection rate of adenomas between solid organ transplant recipients and our control population. Our study was limited by a small number of controls as well as the retrospective nature of the study.