De Novo Colorectal and Pancreatic Cancer in Liver-Transplant Recipients: Identifying the Higher-Risk Populations

Hepatology. 2021 Aug;74(2):1003-1013. doi: 10.1002/hep.31731. Epub 2021 Jun 21.


Background and aims: Gastrointestinal (GI) malignancies are common after liver transplantation. The aim of this study was to identify the risk and timing of the more common GI malignancies, colorectal and pancreatic cancer, to aid in optimizing potential posttransplant screening practices.

Approach and results: Data from the United Network for Organ Sharing database of all adult liver-transplant recipients from 1997 to 2017 were analyzed and a comparison made with cancer incidence from general population data using Surveillance, Epidemiology, and End Results data. Of 866 de novo GI malignancies, 405 colorectal and 216 pancreas were identified. The highest cumulative incidence for colorectal cancer occurred in recipients with primary sclerosing cholangitis (PSC), recipients over the age of 50 with non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC)/cholangiocarcinoma (CCA), and females >50 years with alcohol-associated liver disease and HCC/CCA, with risk increasing above the general population within 5 years of transplant. Patients with PSC and HCC/CCA or NASH and HCC/CCA have the highest cumulative incidence of pancreatic cancer also rising within 5 years following transplant, with those patients >50 years old conferring the highest risk.

Conclusions: These data identify a high-risk cohort that warrants consideration for intensified individualized screening practices for colorectal cancer after liver transplantation. In addition to recipients with PSC, further study of recipients with NASH and HCC/CCA and females with alcohol-associated liver disease and HCC/CCA may be better tailored to colorectal cancer screening ideals. Higher-risk patient populations for pancreatic cancer (PSC and NASH with HCC/CCA) would benefit from further study to determine potential screening practices. GI malignancies occur at higher rates in liver-transplant patients compared with the general population. In the era of individualized medicine, this study identifies the highest-risk transplant recipients (PSC and NASH cirrhosis with coexisting HCC/CCA) who may benefit from altered screening practices for these malignancies.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Bile Duct Neoplasms / epidemiology
  • Bile Duct Neoplasms / pathology
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / pathology
  • Cholangiocarcinoma / epidemiology
  • Cholangiocarcinoma / pathology
  • Cholangitis, Sclerosing / epidemiology
  • Cholangitis, Sclerosing / pathology
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / etiology
  • Colorectal Neoplasms / prevention & control
  • Early Detection of Cancer / standards
  • End Stage Liver Disease / etiology
  • End Stage Liver Disease / surgery*
  • Female
  • Humans
  • Incidence
  • Liver Neoplasms / epidemiology
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / epidemiology
  • Non-alcoholic Fatty Liver Disease / pathology
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / epidemiology*
  • Pancreatic Neoplasms / etiology
  • Pancreatic Neoplasms / prevention & control
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • SEER Program / statistics & numerical data
  • Transplant Recipients / statistics & numerical data