A National Study of Cancer Diagnoses in Irish Liver Transplant Recipients with Primary Sclerosing Cholangitis

Background Primary sclerosing cholangitis (PSC) is associated with an increased risk of cholangiocarcinoma , colorectal and gallbladder cancers. Orthotopic liver transplantation (OLT) patients are at risk of developing de novo malignancies, however limited/conflicting data exists regarding cancer risk post OLT for PSC. Aim To examine all recorded malignancies over 2 decades in OLT-PSC patients; to compare these to non-transplanted PSC cohort; to analyse for any associated factors. Method We studied PSC patients attending SVUH (1/1/1994–30/9/2016). We integrated this database with National Cancer Registry Ireland, to enable accurate determination of number of malignancies. Results 173 PSC pts (75.7% male) have attended SVUH since 1994. 107 (61.8%) have undergone 124 OLT. 27/107 were transplanted for cholangiocarcinoma. 12 de novo cancers (excluding non-melananomatous skin) were found during 737.8 person years of follow-up. Median time to cancer diagnosis post OLT was 5 years. As expected, cholangiocarcinoma as OLT indication (p=0.005) and older age at transplant (p=0.05) were associated with higher mortality. Post-transplant lymphoproliferative disease (PTLD) remains a major complication. 5 pts developed lymphoma post OLT (4.7% of cohort). Two patients developed CRC post OLT; 4 developed colonic dysplasia. 3/4 underwent colectomy. All who developed colonic dysplasia/CRC post OLT had IBD. All 5 colectomies for dysplasia/CRC showed significant co-existing inflammation. Conclusions This represents national cancer figures for PSC-OLT. The rates of PTLD are slightly higher than previously reported. We could not find any association between the development of PTLD and immunosuppressive regimes for IBD post OLT. This study highlights that IBD/PSC patients remain at significant risk of colonic neoplasia after OLT and require intensive surveillance.