Appropriate Timing and Interval for Surveillance Colonoscopy after Liver Transplantation Based on a Single-Centre Experience.

Background: Colon cancer surveillance post liver transplantation (LT) is generally recommended. This study aimed to determine the appropriate timing for the first colonoscopy after LT and the interval for subsequent surveillance colonoscopies based on our single-centre real-world experience.

Methods: The medical records of patients who underwent LT at Pusan National University Yangsan Hospital between December 2008 and March 2024 were reviewed. Patients who underwent colonoscopy at least once after LT were analyzed. After the first post-transplant colonoscopy, subsequent colonoscopies were divided into an intensive and a nonintensive surveillance group based on a 3-year interval.

Results: A total of 404 LT recipients with 1,076 colonoscopies were analyzed. The analysis included pre-transplant (n = 219), first post-transplant (n = 404), and subsequent colonoscopies (n = 453). Cecal intubation failure and poor bowel preparation were higher in the pre-transplant colonoscopy than the post-transplant colonoscopy (3.2% versus 0.8%, p = 0.010; 13.2% versus 4.4%, p < 0.001). Although high-risk polyps were resected in 17 recipients (7.8%) through pre-transplant colonoscopy, they were also discovered in 17 recipients (4.2%) at the first post-transplant colonoscopy. There were no differences in malignancy or high-risk polyp detection between recipients who underwent intensive surveillance (median interval, 22 months) after the first post-transplant colonoscopy and those who did not (median interval, 52 months; 0.6% versus 2.1%, p = 0.381 and 3.7% versus 2.1%, p = 0.598).

Conclusions: Colonoscopy prior to LT may be insufficient; therefore, the first colonoscopy after LT should be performed within 1 year. Subsequent colonoscopies should follow the general surveillance interval.