Department of Medicine, Division of Gastroenterology, School of Medicine and Barnes-Jewish Hospital, Washington University in St. Louis, 660 S Euclid Ave, St Louis, MO, 63110, USA.
Department of Medicine, School of Medicine and Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, 63110, USA.
Dig Dis Sci. 2022 May;67(5):1858-1868. doi: 10.1007/s10620-021-06987-3. Epub 2021 May 10.
Detection and removal of colonic adenomatous polyps (CAP) decreases colorectal cancer (CRC) development, particularly with more or larger polyps or polyps with advanced villous/dysplastic histology. Immunosuppression following solid organ transplantation (SOT) may accelerate CAP development and progression compared to average-risk population but the benefit of earlier colonoscopic surveillance is unclear.
Study the impact of maintenance immunosuppression post-SOT on developmental timing, multiplicity and pathological features of CAP, by measuring incidence of advanced CAP (villous histology, size ≥ 10 mm, ≥ 3 polyps, presence of dysplasia) post-SOT and the incidence of newly diagnosed CRC compared to average-risk age-matched population.
Single-center retrospective cohort study of SOT recipients.
295 SOT recipients were included and were compared with 291 age-matched average-risk controls. The mean interval between screening and surveillance colonoscopies between SOT and control groups was 6.3 years vs 5.9 years (p = 0.13). Post-SOT maintenance immunosuppression mean duration averaged 59.9 months at surveillance colonoscopy. On surveillance examinations, SOT recipients exhibited more advanced (≥ 10 mm) adenomas compared to matched controls (9.2% vs. 3.8%, p = 0.034; adjusted OR 2.38; 95% CI 1.07-5.30).
SOT recipients appear at higher risk for developing advanced CAP, suggesting that earlier surveillance should be considered.
检测和切除结肠腺瘤性息肉 (CAP) 可降低结直肠癌 (CRC) 的发展风险，尤其是对于息肉数量更多或更大、或伴有高级别绒毛状/发育不良组织学特征的息肉。与普通人群相比，实体器官移植 (SOT) 后的免疫抑制可能会加速 CAP 的发展和进展，但早期结肠镜监测的获益尚不清楚。
通过测量 SOT 后高级别 CAP（绒毛状组织学、大小≥10mm、≥3 个息肉、存在异型增生）的发生率和与普通风险年龄匹配人群相比新诊断 CRC 的发生率，研究 SOT 后维持性免疫抑制对 CAP 发展时间、多发性和病理特征的影响。
对 SOT 受者进行单中心回顾性队列研究。
共纳入 295 例 SOT 受者，并与 291 例年龄匹配的普通风险对照者进行比较。SOT 组和对照组之间筛查与监测结肠镜检查的平均间隔时间分别为 6.3 年和 5.9 年（p=0.13）。SOT 受者在监测结肠镜检查时接受维持性免疫抑制的平均时间为 59.9 个月。在监测检查中，SOT 受者出现高级别（≥10mm）腺瘤的比例高于匹配对照者（9.2%比 3.8%，p=0.034；调整后的 OR 2.38；95% CI 1.07-5.30）。
SOT 受者出现高级别 CAP 的风险似乎更高，提示应考虑更早进行监测。
