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Progression to Adenocarcinoma in Barrett's Esophagus After Liver Transplantation.
MedLine Citation:
PMID:  21464795     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND.: The risk for development of certain malignancies after transplantation is well known. Especially in premalignant lesions of the skin and colon, rapid progression is described. The aim of this study is to evaluate the progress of Barrett's mucosa to adenocarcinoma of the esophagus after liver transplantation. METHODS.: Between 2000 and 2009, 895 patients underwent a liver transplantation in our department. All patients had an upper endoscopy as part of the evaluation before transplantation. Patients who had Barrett's mucosa described in their endoscopy report were identified. The records of these patients were retrospectively reviewed. RESULTS.: There were seven patients who had Barrett's mucosa in the preoperative endoscopy. Five of these patients (71%) developed an esophageal adenocarcinoma in a median time of 66 months after liver transplantation. One had stage II disease and four had stage III disease. Three of them underwent neoadjuvant therapy. All patients underwent an en bloc esophagectomy. One patient developed recurrent disease after 12 months and died 37 months after esophagectomy. The other four patients are still alive without recurrence and have a median survival of 16 months. CONCLUSION.: Esophageal cancer after liver transplantation is rare, whereas the risk for progression of Barrett's esophagus to adenocarcinoma is extremely high. Surveillance endoscopy with aggressive endoscopic treatment of the Barrett's is essential for these patients to prevent them from cancer death. Furthermore, immunosuppression therapy based on immunosuppressants with antitumoral effects should be preferred. The esophagectomy with neoadjuvant therapy is also in immunosuppressant patients feasible without increased risk for complications.
Authors:
Arzu Oezcelik; Gernot M Kaiser; Alexander Dechêne; Juergen W Treckmann; Georgios C Sotiropoulos; Renate Reinhardt; Fuat H Saner; Andreas Paul
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-1
Journal Detail:
Title:  Transplantation     Volume:  -     ISSN:  1534-6080     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of General, Visceral and Transplantation Surgery, University of Essen, Essen, Germany. 2 Department of Internal Medicine, Gastroenterology and Hepatology, University of Essen, Essen, Germany.
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