NEOPLASTIC PROGRESSION OF BARRETT'S ESOPHAGUS AMONG ORGAN TRANSPLANT RECIPIENTS: A CASE-CONTROL STUDY

Background and aims: 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). However, the major shortcoming of these reports is the lack of a control population. Therefore, we aim to determine the rates of neoplastic progression in SOT patients with BE compared to controls and also the risk factors associated with progression.
Methods: A retrospective case-control study of all patients with a confirmed diagnosis of BE (age ≥18 years) seen between Jan 2000 and Dec 2021 was conducted. Cases were all BE patients who had SOT; controls were all BE patients with no SOT and no immunosuppressant use. Demographics, endoscopic and histological findings, duration of follow-up (in years), history of fundoplication and immunosuppressant use were abstracted. Patients with ≥1 surveillance endoscopies were included to calculate incidence rates of HGD/EAC. Multivariate logistic regression was done to identify the risk factors associated with progression of BE patients to HGD/EAC.
Results: There were 118 cases with SOT (lung =35, liver=35, kidney=35, heart=14, pancreas=2) and 756 controls with no prior history of SOT or immunosuppressant use. Patients with SOT were predominantly younger (p=0.022); male, had lower body mass index (BMI) and active smokers (p<0.001 for all) (table 1). On multivariate analysis, older age, male gender, BE segment length, higher BMI and hiatal hernia were more likely to be associated with progression of BE to HGD/EAC (table 2). BE patients with immunosuppressant medication use were twice more likely to progress to HGD/EAC (p<0.001) (table 2).
Conclusion: Immunosuppressant use increases the risk of neoplastic progression in patients with BE. Therefore, these patients may need more aggressive surveillance. This study has important clinical implications for surveillance in BE patients with SOT.