Neoplastic Progression of Barrett’s Esophagus Among Organ Transplant Recipients: a Retrospective Cohort Study
Background Several small studies reported high risk of progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE) patients who undergo solid organ transplantation (SOT) and implied that this may be due to immunosuppressant use. However, the major shortcoming of these studies was the lack of a control population. Therefore, we aimed to determine the rates of neoplastic progression in BE patients who underwent SOT and compare to that in controls and identify the predictors of progression. Methods This was a retrospective cohort study of BE patients seen in Cleveland Clinic and affiliated hospitals between January 2000 and August 2022. Demographics, endoscopic and histological findings, history of SOT and fundoplication, immunosuppressant use, and follow-up were abstracted. Results The study population consisted of 3466 patients with BE, of which 115 had SOT (lung 35, liver 34, kidney 32, heart 14, and pancreas 2) and 704 patients on chronic immunosuppressants but no history of SOT. During a median follow-up of 5.1 years, there was no difference in the annual risk of progression between the three groups (SOT=0.61%, no SOT but on immunosuppressants= 0.82%, and no SOT/no immunosuppressants= 0.94%, p=0.72). On multivariate analysis, immunosuppressant use (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.04–1.82, p=0.025) but not SOT (OR 0.39, 95%CI 0.15–1.01, p=0.053) was associated with neoplastic progression in BE patients. Conclusion Immunosuppression is a risk factor for progression of BE to HGD/EAC. Therefore, close surveillance of BE patients on chronic immunosuppressants needs to be considered..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Journal of gastrointestinal surgery - 27(2023), 9 vom: 02. Juni, Seite 1785-1793 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Patel, Vidhi [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Barrett’s esophagus |
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| Anmerkungen: |
© The Society for Surgery of the Alimentary Tract 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s11605-023-05722-9 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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OLC2145652205 |
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| 520 | |a Background Several small studies reported high risk of progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE) patients who undergo solid organ transplantation (SOT) and implied that this may be due to immunosuppressant use. However, the major shortcoming of these studies was the lack of a control population. Therefore, we aimed to determine the rates of neoplastic progression in BE patients who underwent SOT and compare to that in controls and identify the predictors of progression. Methods This was a retrospective cohort study of BE patients seen in Cleveland Clinic and affiliated hospitals between January 2000 and August 2022. Demographics, endoscopic and histological findings, history of SOT and fundoplication, immunosuppressant use, and follow-up were abstracted. Results The study population consisted of 3466 patients with BE, of which 115 had SOT (lung 35, liver 34, kidney 32, heart 14, and pancreas 2) and 704 patients on chronic immunosuppressants but no history of SOT. During a median follow-up of 5.1 years, there was no difference in the annual risk of progression between the three groups (SOT=0.61%, no SOT but on immunosuppressants= 0.82%, and no SOT/no immunosuppressants= 0.94%, p=0.72). On multivariate analysis, immunosuppressant use (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.04–1.82, p=0.025) but not SOT (OR 0.39, 95%CI 0.15–1.01, p=0.053) was associated with neoplastic progression in BE patients. Conclusion Immunosuppression is a risk factor for progression of BE to HGD/EAC. Therefore, close surveillance of BE patients on chronic immunosuppressants needs to be considered. | ||
| 650 | 4 | |a Barrett’s esophagus | |
| 650 | 4 | |a Esophageal adenocarcinoma | |
| 650 | 4 | |a Solid organ transplant | |
| 650 | 4 | |a Immunosuppression | |
| 700 | 1 | |a Sanaka, Madhusudhan R. |4 aut | |
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| 700 | 1 | |a Raja, Siva |4 aut | |
| 700 | 1 | |a Modaresi Esfeh, Jamak |4 aut | |
| 700 | 1 | |a Thota, Prashanthi N. |4 aut | |
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