Kang Eun Ae, Koh Seong-Joon, Kim Ji Won, Lee Kook Lae, Im Jong Pil, Kim Joo Sung, Kim Byeong Gwan
Department of Internal Medicine and Liver Research Institute, Seoul National University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University School of Medicine, Seoul, Korea.
Turk J Gastroenterol. 2018 May;29(3):316-324. doi: 10.5152/tjg.2018.17458.
BACKGROUND/AIMS: Patients with liver transplantation are at increased risk of developing new malignancy because of the prolonged immunosuppression after transplantation. The aims of this study were to investigate whether advanced colorectal neoplasms occurs more in liver transplant recipients compared to healthy individuals and to evaluate the effect of immunosuppression on advanced colorectal neoplasia.
This was a retrospective, single-centered, case-control study. We reviewed 348 liver transplant patients who had undergone a colonoscopy after liver transplantation from 1991 to 2012. Healthy controls from asymptomatic individuals who had undergone colonoscopy for screening purposes were randomly selected and reviewed.
Advanced colorectal neoplasms were identified in 17 of the 348 patients (4.9%). The risk of advanced colorectal neoplasia was 3.6 times greater in liver transplant patients (odds ratio [OR] 3.578; 95% confidence interval [CI] 1.578-8.115; p=0.001). The risk of developing colon cancer was 8.4 times higher in transplant patients (OR 8.416; 95% CI 1.808-39.172; p=0.001).
Liver transplant recipients were at a high risk of colorectal cancer. Therefore, colonoscopy surveillance after liver transplantation is recommended. Immunosuppressive therapy could facilitate carcinogenesis.
背景/目的：肝移植患者由于移植后长期免疫抑制，发生新发恶性肿瘤的风险增加。本研究的目的是调查与健康个体相比，晚期结直肠肿瘤在肝移植受者中是否更常见，并评估免疫抑制对晚期结直肠肿瘤形成的影响。
这是一项回顾性、单中心病例对照研究。我们回顾了1991年至2012年间348例肝移植后接受结肠镜检查的患者。从因筛查目的接受结肠镜检查的无症状个体中随机选择健康对照并进行回顾。
348例患者中有17例（4.9%）被诊断为晚期结直肠肿瘤。肝移植患者发生晚期结直肠肿瘤的风险高3.6倍（优势比[OR]3.578；95%置信区间[CI]1.578 - 8.115；p = 0.001）。移植患者患结肠癌的风险高8.4倍（OR 8.416；95% CI 1.808 - 39.172；p = 0.001）。
肝移植受者患结直肠癌的风险很高。因此，建议肝移植后进行结肠镜监测。免疫抑制治疗可能促进致癌作用。
