Colorectal cancer (CRC) risk in patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) is increased compared to the general population. The combination of IBD and PSC is associated with an increased risk for dysplasia and CRC following orthotopic liver transplant (OLT) for PSC. Considering the importance of surveillance colonoscopy, we evaluated PSC patients following OLT for the incidence of dysplasia/CRC. Methods: A cohort of 85 PSC patients were evaluated post-OTL. Data collected included age, gender, IBD diagnosis, colectomy history, PSC duration, re-transplantation, timing of colonoscopy, and mortality. Results: There were 101 liver transplants in 85 patients with primary indication of PSC out of 1308 OLTs performed from 2002-2016. Of the 85 PSC patients, 64 (75%) had underlying IBD with a median duration of 14 years prior to OTL. The IBD-PSC patient was younger at time of transplant (46 vs 54 years, p = 0.0086), with 83% having Ulcerative Colitis. 48 of the 64 IBD-PSC patients had an intact colon at OTL. Of the 48 patients, 9 presented with colorectal dysplasia or carcimoma within 3 years of OTL, including two with CRC and one CRC death. Six patients had dysplasia with five undergoing a colectomy post-OTL with a mean duration of 4.4 years from transplant. One patient had evidence of epithelial changes indefinite for dysplasia and has undergone on-going surveillance. Overall, those with dysplasia/CRC were diagnosed with UC at a significantly younger age; 20 vs 32 years, p< 0.0016 (Table 1). Further, the mortality rate was higher for IBD subjects compared to non-IBD patients (Figure 1). Conclusions: The risk of CRC in patients with IBD results in a significant risk for the development of dysplasia and CRC following transplant for PSC. It is of utmost importance that this high risk population undergo recommended CRC surveillance to prevent this risk and declines in post-transplant survival.
