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389. ORTHOTOPIC LIVER TRANSPLANTATION, PSC, IBD AND COLORECTAL CARCINOMA
  1. A.J. Hughes,
  2. B. Gunson,
  3. M.J. Langman,
  4. J. Neuberger
  1. S.A. Khan1-1,
  2. S.D. Taylor-Robinson1-1,
  3. M.B. Toledano1-2,
  4. P. Elliott1-2,
  5. H.C. Thomas1-1
  1. The Liver Unit, 1-1Dept of Medicine A and 1-2Dept of Epidemiology, Imperial College School of Medicine, St Mary's Hospital Campus, South Wharf St, London W2 1PG, UK

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Aim: We reviewed our centre's experience of prevalence of IBD in patients undergoing transplantation for PSC, indication for colectomy and incidence of colorectal carcinoma.

Methods: Patients were identified from a prospectively maintained database then retrospective case note analysis was undertaken.

Results: 936 patients underwent orthotopic liver transplantation between January 1982 & February 1999 and subsequently followed up for >12 months. 105 were transplanted for PSC (with no evidence of cholangiocarcinoma), 78 men and 27 women with a mean age of 45.5 years were followed up for a median of 61 months (range 13–143). Pre-transplant 66 patients (62.9%) were diagnosed with UC and 4 (3.8%) with Crohns . Post-transplant this rose to 78 (74.3%) with U.C. and 5 (4.8%) with Crohns. Colectomy for non malignant indications: pre-transplant - 9 (2 dysplasia, 7 symptomatic), peri-operatively - 1 for dysplasia , post-operatively - 5 (1 dysplasia, 4 symptomatic). 7 patients, all with UC, developed colorectal adenocarcinoma and 1 caecal lymphoma. Incidence of colorectal adenocarcinoma in patients transplanted for PSC with an intact colon was 7.4% compared with 0.8% for the rest of transplant group (p<0.05) and 12.3% in patients with UC diagnosed prior to transplantation for PSC. Malignancy arose after a median of 4.5 yrs and all had colitis for > 18yrs.

Conclusion: Patients with PSC and longstanding UC have a considerably increased risk of developing colorectal adenocarcinoma post liver transplantation and should be screened aggressively.

390. WORLDWIDE TRENDS IN MORTALITY RATES FOR HEPATOBILIARY AND PANCREATIC TUMOURS, 1979–1997

Background: The age-standardised mortality rate (ASMR) per 100,000 population for hepatocellular carcinoma (International Classification of Disease-9 155.0) is increasing in several countries including USA and Japan; but in England & Wales we previously reported an increase in ASMR for intrahepatic cholangiocarcinoma (ICD-9 155.1) only. To investigate this further we analysed mortality statistics from North America, Japan, Australia and Europe to compare ASMR of subcategories of hepatobiliary and …

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