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Neoplastic Progression of Barrett’s Esophagus Among Organ Transplant Recipients: a Retrospective Cohort Study

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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.


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.


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.


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.

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Fig. 1



analysis of variance

BE :

Barrett’s esophagus


body mass index

CI :

confidence interval


deoxyribonucleic acid


esophageal adenocarcinoma



EARs :

excess absolute risks

HR :

hazard ratio

HH :

hiatal hernia


high-grade dysplasia

H/o :

history of


indefinite for dysplasia


intramucosal adenocarcinoma


low-grade dysplasia

m-TOR :

mammalian target of rapamycin


non-dysplastic Barrett’s esophagus

No. :


OR :

odds ratio

RR :

relative risk


solid organ transplantation

SIRs :

standardized incidence ratios


tumor necrosis factor


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Authors and Affiliations



Study conceptualization: Patel, Thota

Data acquisition: McMichael, Patel, Thota, Bena, Barron, Raja

Data interpretation: Bena, Patel, Thota, Sanaka, Qin, Barron, Raja, Beveridge, Modaresi Esfeh

Drafting of manuscript: Patel, Thota, Sanaka, Qin, Barron, Raja, Beveridge, Modaresi Esfeh

Final approval: Patel, McMichael, Bena, Sanaka, Qin, Beveridge, Barron, Raja, Modaresi Esfeh, Thota

Agreement to be accountable for all aspects of the work: Patel, McMichael, Bena, Sanaka, Qin, Beveridge, Barron, Raja, Modaresi Esfeh, Thota

Corresponding author

Correspondence to Prashanthi N. Thota MD.

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Patel, Vidhi, and Thota, Prashanthi N., were selected for lecture presentation during Digestive Disease Week® 2023 by SSAT Scientific Program Committee.

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Patel, V., Sanaka, M.R., Qin, Y. et al. Neoplastic Progression of Barrett’s Esophagus Among Organ Transplant Recipients: a Retrospective Cohort Study. J Gastrointest Surg 27, 1785–1793 (2023).

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