Some Liver Transplant Patients at Higher Risk of Colorectal Cancer

Patients with primary sclerosing cholangitis and inflammatory bowel disease who undergo liver transplants have an increased risk of developing colorectal cancer, according to British researchers.

About 70 percent of the patients with primary sclerosing cholangitis, a bile duct disease that often leads to cirrhosis of the liver, also have an inflammatory bowel disease, especially ulcerative colitis in which the colon becomes inflamed and ulcerated.

Researchers at Queen Elizabeth Hospital in Birmingham, in a study of 152 patients with primary sclerosing cholangitis who underwent 173 liver transplants between 1986 and 2000, found that the incidence of colorectal cancer after the transplant was 5.3 percent compared with 0.6 percent in those without the disease.

"All colorectal cancers in the primary sclerosing cholangitis group were in [transplant] patients with inflammatory bowel disease and an intact colon," the researchers reported in the journal Transplantation.

"The cumulative risk of developing colorectal cancer in the 83 [transplant] patients with an intact colon andinflammatory bowel diseas was 14 percent after 5 years and 17 percent after 10 years," they said.

They added that "the cause of death in [the transplant] patients with colorectal cancer was cancer related in 75 percent of cases."

"Patients with primary sclerosing cholangitis undergoing liver transplants with a long history of ulcerative colitis and pancolitis have an increased risk of developing colorectal cancer with reduced survival," the researchers concluded. "We advocate long-term aggressive colonic surveillance and colectomy in selected high-risk patients with longstanding severe colitis."

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