Is a stricter colonoscopy screening protocol necessary in liver transplant recipients? Comparison with an average-risk population.

BACKGROUND: The epidemiology of colorectal neoplasm in liver transplantation recipients has not been fully determined. OBJECTIVE: The aim of this study was to evaluate the prevalence of colorectal neoplasm in liver transplantation recipients and to compare it with that in the average-risk population. DESIGN: This study was retrospective and observational. SETTING: This study was conducted at a tertiary care center. PATIENTS: From January 2000 to December 2011, 257 liver transplantation recipients who had undergone posttransplant colonoscopy were enrolled. A total of 1028 control subjects matched for age, sex, and calendar year of the index colonoscopy were recruited from those who had undergone screening colonoscopy at our institution. MAIN OUTCOME MEASURES: Colonoscopy findings were compared between the 2 groups. The prevalence of overall and advanced colorectal neoplasms and their risk factors were investigated. RESULTS: The median age was 54 years, and each group consisted of approximately 75.5% men. The prevalence of overall and advanced colorectal neoplasm was 35.4% and 5.8% in liver transplantation recipients and 41.7% and 3.5% in controls (p = 0.07 and p = 0.11). The prevalence of invasive colorectal cancer was higher in liver transplantation recipients than in controls (0.8% versus 0.0%, p = 0.04). The prevalence of overall and advanced colorectal neoplasms in liver transplantation recipients younger than 40 years was higher than age-matched controls (p = 0.003 and p = 0.04). LIMITATIONS: The retrospective design was a limitation of this study. CONCLUSIONS: The prevalence of colorectal neoplasms may not increase in liver transplantation recipients compared with the general population. However, the prevalence of invasive colorectal cancer may be higher in liver transplantation recipients. A prospective study is warranted to determine an appropriate colorectal cancer screening strategy for liver transplantation recipients.