Int J Colorectal Dis (2008) 23:47–51 DOI 10.1007/s00384-007-0379-7
ORIGINAL ARTICLE
The prevalence of colorectal neoplasia in patients with end-stage renal disease: a case–control study Sharon Lee & Nir Wasserberg & Patrizio Petrone & Jason Rosca & Rick Selby & Adrian Ortega & Howard S. Kaufman
Accepted: 8 August 2007 / Published online: 13 September 2007 # Springer-Verlag 2007
Abstract Background and Purpose The scarcity of organs for transplantation has led to aggressive pretransplant evaluations. Many younger kidney transplant patients with endstage renal disease, who would be ordinarily at average risk for colorectal cancer, undergo screening colonoscopy as part of this evaluation. The purpose of this study was to determine the prevalence of colorectal neoplasia in patients with end-stage renal disease who are potential transplant candidates. Materials and methods We performed a retrospective chart review analysis on 57 kidney transplant candidates who underwent pretransplant screening colonoscopy between August 1999 and December 2004. The control group was comprised of 60 age- and gender-matched subjects without end-stage renal disease who underwent routine screening colonoscopy. Results The prevalence of polyps in end-stage renal disease patients was 37 vs 22% in the control group (p=0.07, not significant). None of the risk factors studied were found to predict the presence of polyps in the study group.
Sharon Lee and Nir Wasserberg equally contributed to the manuscripts preparation. S. Lee : N. Wasserberg : P. Petrone : J. Rosca : R. Selby : A. Ortega : H. S. Kaufman Division of Colorectal and Pelvic Floor Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA N. Wasserberg (*) Department of surgery B, Beilinson Campus, Rabin Medical Center, Petach Tiqva 49100, Israel e-mail:
[email protected]
Conclusion These results suggest that screening guidelines for colorectal cancer for the general population should be adequate for potential kidney transplant recipients. Keywords End-stage renal disease . Colonoscopy . Kidney transplant . Colorectal neoplasia . Colorectal polyps
Introduction In the USA, colorectal cancer is the third most common cancer among both men and women and the second leading cause of cancer death. The National Cancer Institute indicates that incidence rates of colorectal cancer increase with age, especially after the age of 50 [1]. Colonoscopy has been useful in detecting early colorectal cancers and adenomatous polyps and permits removal of pathology and biopsy of cancer during the procedure. The American Gastroenterological Association recommends colonoscopy as one option for colorectal cancer screening for average risk adults who are more than 50 years old every 10 years [2]. Other options for screening include fecal occult blood testing, sigmoidoscopy, and double-contrast barium enema. Men and women who fall into higher-risk categories should also be screened at a younger age: These categories include a positive family history of colorectal cancer, hereditary nonpolyposis colorectal cancer, or familial adenomatous polyposis, and a personal history of inflammatory bowel disease [2]. End-stage renal disease (ESRD) patients may be at an increased risk for developing certain types of cancers because of a weakened immune system, chronic infections and inflammatory conditions, impaired DNA repair, decreased antioxidant defense, and the accumulation of carcinogens [3]. Several studies have demonstrated increased rates of cancers in ESRD patients on dialysis
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compared to the general population [4–8]. Renal transplant candidates with ESRD often undergo chronic dialysis before transplantation and must receive chronic immunosuppressive therapies after the transplant is performed, which may increase their risk of certain neoplasms [9]. Immunosuppression may also increase the risk of progression of already-existing malignancies and may be an important cause of increased morbidity and mortality in renal transplant patients [10]. Because donor organs are in short supply, kidney transplant candidates with ESRD undergo rigorous evaluations before transplantation. As a rule, these assessments include screening colonoscopies. If renal transplant candidates are at higher risk for colorectal neoplasm, colonoscopic evaluations of these patients before kidney transplantation may prove beneficial and change patient management. The purpose of this study was to determine the prevalence of colorectal neoplasia in patients with ESRD and to identify associated predictive risk factors for colorectal polyps in these patients.
Materials and methods The medical records of all kidney transplants candidates who had undergone a pretransplant colonoscopy between March 2000 and April 2005 at the University of Southern California (USC) University Hospital were retrospectively reviewed. All colonoscopies were performed by senior gastroenterologists and colorectal staff. The medical records were evaluated for the presence and for the distribution, number, and histopathology of colorectal polyps that were detected during pretransplant colonoscopy and for the association of risk factors for development of polyps including age, sex, ethnicity, diabetes mellitus, family history of cancer, history of colonic polyps, cholecystectomy, and indications for colonoscopy (diarrhea, abdominal pain, hematochezia, anemia, and constipation). The results were compared with age- and gender-matched controls without ESRD, who underwent screening or diagnostic colonoscopy at the USC University Hospital and Los Angeles County/USC Hospital. This study was granted approval by the Health Sciences Institutional Review Board at USC. Statistical analysis was performed using Pearson’s chisquared test with statistical significance determined at the p
