Safety and Outcomes of Colonoscopy in Cardiac Transplant Candidates with Severely Versus Non-severely Reduced Left Ventricular Function: A Single-Center Retrospective Cohort.

Abstract

Background: Pre-cardiac transplant evaluation, including colorectal cancer screening, is vital for organ allocation. Data on colonoscopy risks in transplant candidates are limited to retrospective analyses with varying methodologies. Literature assessing colonoscopy alone without esophagogastroduodenoscopy is even more limited. We studied adverse events and clinical outcomes of pre-transplant screening colonoscopy in patients stratified by ejection fraction (EF).

Methods: Charts were reviewed at Saint Luke's Hospital in Kansas City, Missouri, between 2014 and 2023. Cohorts were divided by EF: severe (EF < 30%) and non-severe (EF ≥ 30%). Demographics and clinical outcomes were compared using descriptive statistics and chi-square tests, with a p-value: < 0.05. Outcomes included adverse events and adenoma or colorectal cancer detection.

Results: Among 322 patients, 231 had EF < 30% and 91 had EF ≥ 30%. Adverse events were similar in both cohorts (p > 0.05 for all). No severe events were observed during colonoscopy as classified by the American Society of Gastrointestinal Endoscopy (Cotton et al. (2010) Gastrointest Endosc. 71:446-454) Adenoma detection rate in the EF ≥ 30% group was 37.1 and 26.6% in the EF < 30% group. Analysis showed no significant differences in adenoma detection (p = 0.08).

Conclusions: Our study provides new data on the safety and diagnostic performance of pre-transplant colonoscopy in patients with severe and non-severely reduced EF. While minor adverse events were commonly observed, no severe complications occurred during colonoscopy. Adverse clinical outcomes were comparable between cohorts regardless of EF severity, and severity did not appear to significantly impact detection of adenomas; however, bowel prep and colonoscopy were performed in a closely monitored, inpatient setting.