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PWE-152 Primary Sclerosing Cholangitis-inflammatory Bowel Disease Is Associated With An Increased Frequency Of Post-transplant Colonic Lymphoma
  1. PJ Trivedi1,
  2. T Wright1,
  3. J Robinson1,
  4. K-K Li1,
  5. B Gunson2,
  6. D Adams1,
  7. J Ferguson3,
  8. G Hirschfield1
  1. 1NIHR Biomedical Research Unit and Centre for Liver Research, UK
  2. 2NIHR Biomedical Research Unit, University of Birmingham, UK
  3. 3Liver Unit, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK

Abstract

Introduction Post-transplant lymphoproliferative disease (PTLD) is a recognised complication of liver transplantation (LT). Although small intestinal involvement is common, factors predisposing to colonic disease are not well characterised.

Methods A case-note review of all patients undergoing liver transplantation (1982–2013) was performed, and subsequently cross-referenced with an institutional lymphoma database comprising all biopsy-proven PTLD cases to date. Putative risk factors for development of colonic lymphoma were analysed using SPSSv21.

Results Over a 31-year adult ‘first liver’ transplant experience (No. of recipients=2872), 72 cases of post-LT lymphoproliferative disease were identified and most commonly observed in the context of primary biliary cirrhosis (PBC; n = 20) and primary sclerosing cholangtitis (PSC; n = 14). Overall, intestinal involvement was observed in 18/72 patients, representing predominantly small bowel disease (n = 12). Colonic lymphoma occurred only in individuals transplanted for PSC (n = 6; median 5.0yrs post-transplant; IQR: 3.2–11.7), all of who had underlying colitis. In all cases, disease was a diffuse large B-cell lymphoma; however, only 2 patients had EBV-(LMP)-positive tumours, from which only 1 a detectable serum EBV-titre (qPCR). There were no significant associations with age at transplantation, male gender, treatment with azathioprine or tacrolimus, duration of azathioprine or calcineurin inhibitor exposure, or onset of colitis post-LT. Only one patient (each) with PTLD occurring in the context of cardiothoracic (n = 6) and renal (n = 32) transplantation developed large bowel disease, and under these circumstances was part of a disseminated lymphomatous process.

Conclusion PSC/colitis is associated with development of colonic lymphoma post-LT. Additional risk factors have yet to be identi, UKfied.

Disclosure of Interest None Declared.

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