Department of Surgery, St Joseph's Hospital and Medical Center, Phoenix, AZ.
Creighton University School of Medicine, Phoenix, AZ.
J Am Coll Surg. 2021 May;232(5):717-725. doi: 10.1016/j.jamcollsurg.2020.12.053. Epub 2021 Jan 21.
Solid organ transplant recipients are at increased risk for noncutaneous neoplasms, including colorectal cancer (CRC). We evaluated precancerous lesions detected by post-transplant surveillance colonoscopy to infer the rate at which new adenomas develop in this population.
We reviewed all patients who underwent lung transplant between January 2013 and August 2017 at our institution. Those with post-transplant survival <1 year, personal history of CRC, previous lung transplant, and lack of pretransplant colonoscopy were excluded.
During the study period, 411 patients underwent lung transplant; 237 met inclusion criteria. Median age at transplant was 63.6 (interquartile range [IQR] 59.2-68.3) years. Most recipients were immunosuppressed with a combination of prednisone, tacrolimus, and mycophenolate mofetil. At least 1 adenoma was found in 92 patients (38.8%) pretransplant and in 118 patients (49.8%) from 1 to 5 years post-transplant, with 68.6% identified at 1 year. Most adenomas were identified proximal to the splenic flexure. Multiple (≥3) adenomas were found in 31.4% of positive colonoscopies. Within 5 years after transplant, patients with a positive pretransplant colonoscopy had significantly more positive post-transplant colonoscopies than patients with a negative pretransplant colonoscopy (63.0% vs 41.4%, p < 0.001). No de novo CRC was identified.
Lung transplant recipients have a significantly higher risk of adenoma formation than average-risk adults (25%-30% national detection rate). This increase occurs in the early post-transplant period (within 3 years). An enhanced CRC surveillance protocol for lung transplant recipients is needed.
实体器官移植受者发生非皮肤性肿瘤（包括结直肠癌）的风险增加。我们评估了移植后监测结肠镜检查发现的癌前病变，以推断该人群中新发腺瘤的发展速度。
我们回顾了 2013 年 1 月至 2017 年 8 月期间在我院接受肺移植的所有患者。排除移植后生存时间<1 年、结直肠癌个人史、既往肺移植和缺乏移植前结肠镜检查的患者。
在研究期间，有 411 例患者接受了肺移植；其中 237 例符合纳入标准。移植时的中位年龄为 63.6 岁（四分位距 [IQR]59.2-68.3）。大多数受者接受了泼尼松、他克莫司和吗替麦考酚酯联合免疫抑制治疗。在移植前至少有 1 个腺瘤的患者有 92 例（38.8%），在移植后 1 至 5 年的患者有 118 例（49.8%），其中 68.6%在移植后 1 年发现。大多数腺瘤位于脾曲附近。阳性结肠镜检查中发现 31.4%的患者有多个（≥3）腺瘤。在移植后 5 年内，与移植前结肠镜检查阴性的患者相比，移植前结肠镜检查阳性的患者有更多的阳性移植后结肠镜检查（63.0% vs 41.4%，p<0.001）。未发现新诊断的结直肠癌。
肺移植受者发生腺瘤的风险明显高于普通成年人（全国检出率为 25%-30%）。这种增加发生在移植后早期（3 年内）。需要为肺移植受者制定增强的结直肠癌监测方案。
