The Incidence And Influencing Factors Of Colorectal Adenomatous Polyp After Liver Transplantation

Objectives:The majority of colorectal cancer develop out of precancerous lesions,so-called colon adenomas.Early prevention and treatment can improve the prognosis of post-liver transplantation colorectal cancer.After liver transplantation,patients require immunosuppressive medication.Compared with the general population,their risk of cancer and pre-cancerous lesion is higher.The aim was to study the incidence and risk factors of colorectal adenomatous polyps in liver transplant recipients,so as to provide clinical reference for improving the prognosis and quality of life in liver transplant recipients.Methods:The study enrolled participants who accepted liver transplantation between January 2004 and May 2019.And the results of their postoperative colonoscopy were followed.Age and sex-matched healthy people who underwent colonoscopy were selected as health examination group(1:3 ratio).The patients with hepatitis B,cirrhosis and liver cancer were collected as hepatitis B group,cirrhosis group and liver cancer group.The incidence of colorectal adenomatous polyps in liver transplant recipients was compared with other groups.Data collected of liver transplant recipients included age,sex,BMI,use of tobacco,alcohol intake,medical history of diabetes or hypertension,age of transplantation,time from liver transplantation to colonoscopy,pre-liver transplantation basic disease,species and concentration of immune inhibitors,part of the test results(including blood fat and tumor markers),postoperative non-steroidal anti-inflammatory drug(aspirin),date and the results of colonoscopy(including colonoscopic appearance and pathology result),reexamination of colonoscopy(including colonoscopic appearance and pathology result).According to the pathological results of colonoscopy,liver transplant recipients were divided into the colorectal adenomatous polyp group(adenoma group)and the non-colorectal adenomatous polyp group(non-adenoma group).Single factor analysis was conducted on the collected relevant influencing factors.For the statistically significant results,multivariate analysis was performed using logistic regression.The influencing factors of colorectal adenomatous polyps after liver transplantation were preliminarily discussed.Results:79 liver transplant recipients were included in this study.The incidence of colorectal adenomatous polyps was 36.71%(29/79).The incidence of colorectal adenomatous polyps of health examination group,hepatitis B group,cirrhosis group and liver cancer group was 28.69%(68/237,P=0.290)?29.55%(26/88,P=0.325)?41.57%(37/89,P=0.927)?35.16%(32/91,P=0.834)respectively.Single factor analysis showed that the level of carcinoembryonic antigen(CEA)(P=0.011)and use of cyclosporine(P=0.007)were risk factors for colorectal adenomatous polyps after liver transplantation.Logistic regression analysis of these two factors showed that the level of CEA(P=0.004,OR=2.361)and use of cyclosporine(P=0.007,OR=17.524)were independent risk factors for colorectal adenomatous polyps after liver transplantation.Conclusion:Compared with the control group,liver transplant recipients had an increased risk of colorectal adenomatous polyps after operation,which was probably related to the level of CEA and use of cyclosporine after liver transplantation.In order to improve the prognosis of liver transplant recipients,the colonoscopy screening should be emphasized.Those with risk factors should pay more attention and have more frequent screening.