Madeline E. Abrams, Eleanor Keller, Carolina Lemos, Matthew Regan, Desire Cruz O'Connell, Sanjay M. Salgado, Elena Donald, Ruben Salazar, Carolyn Hennecken, Jayant K. Raikhelkar, Farhana Latif, Kevin J. Clerkin, Gabriel Sayer, Nir Uriel, Ersilia M. DeFilippis
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Patient-level data were collected, including demographics, laboratory studies, and use of pre-HT mechanical circulatory support (MCS); additionally, electronic medical records were reviewed to identify methods of CRC screening and surveillance. Guideline consensus recommendations were used to determine if patients were up-to-date with screening. The date of last follow-up was October 2024. Multivariable logistic regression was used to assess predictors of colonoscopy use for screening pre- and post-HT.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Between 2013 and 2023, 650 patients underwent HT. A total of 436 (67.1%) were of the recommended age for CRC screening, and 386 (88.5%) underwent CRC screening pre-HT. Fifty (13%) screened patients had high-risk features for CRC. Colonoscopy was utilized in 342 (88.6%) cases. The use of CT colonography was more frequent in those on MCS or inotropic support at the time of screening (32.9% vs. 6.6%, <i>p</i> < 0.00001). 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引用次数: 0
摘要
由于免疫抑制，实体器官移植与新发恶性肿瘤的风险增加有关。然而，心脏移植（HT）候选人和接受者的结直肠癌（CRC）筛查指南与一般人群相同。我们的目的是评估在接受HT治疗前后的CRC筛查实践。方法：我们对2013年至2023年在大容量移植中心的成人HT受体进行了回顾性队列研究。收集患者层面的数据，包括人口统计学、实验室研究和ht前机械循环支持（MCS）的使用；此外，对电子病历进行了审查，以确定CRC筛查和监测的方法。指南一致建议用于确定患者是否接受了最新的筛查。最后一次跟进的日期是2024年10月。多变量逻辑回归用于评估结肠镜检查用于筛查ht前后的预测因素。结果：2013年至2023年间，650例患者接受了HT治疗。436例（67.1%）符合推荐的CRC筛查年龄，386例（88.5%）接受了ht前的CRC筛查。50例（13%）筛查患者具有结直肠癌的高危特征。结肠镜检查342例（88.6%）。在筛查时接受MCS或肌力支持的患者中，CT结肠镜检查的频率更高（32.9%比6.6%,p < 0.00001）。使用临时MCS与结肠镜筛查的低几率相关（aOR 0.05, 95% CI 0.020.14, p < 0.0001）。91例（26.6%）HT前结肠镜检查发现腺瘤性息肉，1例移植前筛查发现CRC。共有330例（50.8%）患者在ht后进行结肠镜检查，其中171例（51.8%）完成筛查。老年患者术后接受结肠镜检查的几率较高（aOR 1.06, 95% CI 1.02-1.1, p = 0.001）。结肠镜检查发现腺瘤性息肉33例（19.3%），结直肠癌发生率1.2%。结论：进一步的研究应该探索移植前和移植后人群的最佳筛查指南。
Screening and Surveillance for Colorectal Cancer Before and After Heart Transplantation
Introduction
Solid organ transplantation is associated with an increased risk of de novo malignancy due to immunosuppression. However, colorectal cancer (CRC) screening guidelines for heart transplantation (HT) candidates and recipients are the same as for the general population. We aimed to evaluate CRC screening practices among HT recipients both before and after HT.
Methods
We conducted a retrospective cohort study of adult HT recipients between 2013 and 2023 at a large volume transplant center. Patient-level data were collected, including demographics, laboratory studies, and use of pre-HT mechanical circulatory support (MCS); additionally, electronic medical records were reviewed to identify methods of CRC screening and surveillance. Guideline consensus recommendations were used to determine if patients were up-to-date with screening. The date of last follow-up was October 2024. Multivariable logistic regression was used to assess predictors of colonoscopy use for screening pre- and post-HT.
Results
Between 2013 and 2023, 650 patients underwent HT. A total of 436 (67.1%) were of the recommended age for CRC screening, and 386 (88.5%) underwent CRC screening pre-HT. Fifty (13%) screened patients had high-risk features for CRC. Colonoscopy was utilized in 342 (88.6%) cases. The use of CT colonography was more frequent in those on MCS or inotropic support at the time of screening (32.9% vs. 6.6%, p < 0.00001). The use of temporary MCS was associated with lower odds of screening with colonoscopy (aOR 0.05, 95% CI 0.020.14, p < 0.0001). Adenomatous polyps were found on 91 (26.6%) pre-HT colonoscopies, and CRC was diagnosed in one HT recipient on pretransplant screening. A total of 330 (50.8%) patients were due for colonoscopy post-HT, of whom 171 (51.8%) completed screening. Older patients had higher odds of undergoing colonoscopy post-HT (aOR 1.06, 95% CI 1.02–1.1, p = 0.001). Adenomatous polyps were found on 33 (19.3%) of post-HT colonoscopies, and the incidence of CRC post-HT was 1.2%.
Conclusions
Further studies should explore optimal screening guidelines in the pre- and posttransplant population.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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