EP774 - Colorectal Cancer after Solid Organ Transplantation: Is More Frequent Screening Indicated?

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Purpose/Background: Organ transplantation (OT) occurs in a complex, comorbid population with unique challenges that impact their participation in preventative healthcare. Current colorectal screening parameters include adjusted schedules for personal or familial history of cancer and polyposis syndromes. However, there is no protocol for adjusting surveillance patterns for patients after OT. Our aim is to describe the population of OT patients with colorectal cancer, and demonstrate the patterns of colorectal cancer screening after OT.

Methods/Interventions: We conducted a retrospective, observational, multi-center study that included all patients with colon, rectal and anal cancer diagnoses following solid OT. Data was collected from retrospective chart review, including demographics, medical and surgical history.

Results/Outcomes: From 2006-2023, 48 patients with colon, rectal or anal cancers following OT were identified. 9 patients were excluded from study analysis due to unavailable endoscopy data. Of the remaining 39 patients, 64% (n=25) were male and 36% (n=14) were female. In addition, 74% (n=29) identified as caucasian, 13% (n=5) as black, and 13% (n=5) as hispanic. The average age of malignant diagnosis was 61 years (median of 61 years). The average time from transplant to malignancy was 9.5 years, with a median of 9 years. On review of post-transplant colonoscopy surveillance, 67% (n=26) were compliant with a 10 year screening colonoscopy after organ transplantation, and half of these patients were screened more aggressively (every 1-5 years) based on personal history of IBD or polyps. Age was not a factor in determining colonoscopy interval (p=0.036), but eventual cancer diagnosis occurred faster in those compliant with screening (8.2 years vs. 11.9 years, p=0.034). Men were found to be more often non-compliant (52%, p=0.003).

Risk factors outside of transplant immunosuppression included obesity and diabetes (49%), inflammatory bowel disease (13%), genetic disease (13%), immunosuppressive viruses (13%), prior cancer history (26%), radiation exposure (5%), biologics or steroid usage (15%). Transplant history included 5 hearts (13%), 17 kidneys (44%) and 17 livers (44%), with 26% of these patients reporting history of multiple organ transplants. Cancer history included 28 colon cancers (72%), 4 rectal cancers (10%) and 7 anal cancers (18%), with 59% presenting symptomatically and 42% diagnosed with locally advanced or metastatic disease.

Conclusion/Discussion: Transplant recipients are a complex and co-morbid population at risk of non-adherence to routine risk colonoscopy surveillance for colorectal and anal cancer. They may face increased risk of malignancy owing to any number of factors, including their immune suppression and their chronic disease. Given most cancers were diagnosed within a decade of transplant, colorectal cancer screening should be prioritized within this population. Additionally, the proportion of patients presenting with symptomatic or advanced disease suggests a need for adjusted colorectal cancer screening intervals.