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

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Abstract

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.

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Fig. 1

Abbreviations

ANOVA :

analysis of variance

BE :

Barrett’s esophagus

BMI :

body mass index

CI :

confidence interval

DNA :

deoxyribonucleic acid

EAC :

esophageal adenocarcinoma

EGD :

esophagogastroduodenoscopy

EARs :

excess absolute risks

HR :

hazard ratio

HH :

hiatal hernia

HGD :

high-grade dysplasia

H/o :

history of

IND :

indefinite for dysplasia

IMAC :

intramucosal adenocarcinoma

LGD :

low-grade dysplasia

m-TOR :

mammalian target of rapamycin

NDBE :

non-dysplastic Barrett’s esophagus

No. :

number

OR :

odds ratio

RR :

relative risk

SOT :

solid organ transplantation

SIRs :

standardized incidence ratios

TNF :

tumor necrosis factor

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA

    Vidhi Patel MD, Madhusudhan R. Sanaka MD, Yi Qin MD, Claire Beveridge MD, Jamak Modaresi Esfeh MD & Prashanthi N. Thota MD

  2. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA

    John McMichael PhD

  3. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    James Bena MS

  4. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA

    John Barron MD & Siva Raja MD

Authors
  1. Vidhi Patel MD
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  2. Madhusudhan R. Sanaka MD
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  3. Yi Qin MD
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  10. Prashanthi N. Thota MD
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Contributions

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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The authors declare no competing interests.

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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). https://doi.org/10.1007/s11605-023-05722-9

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