Abstract：
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.
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.
摘要：
背景：一些小型研究报告了接受实体器官移植（SOT）的Barrett食管（BE）患者进展为高度发育不良（HGD）和食管腺癌（EAC）的高风险，并暗示这可能是由于使用免疫抑制剂所致。然而,这些研究的主要缺点是缺乏对照人群.因此,我们旨在确定接受SOT的BE患者的肿瘤进展率,并与对照组进行比较,确定进展的预测因素.
方法：这是2000年1月至2022年8月在克利夫兰诊所和附属医院就诊的BE患者的回顾性队列研究。人口统计,内窥镜和组织学发现，SOT和胃底折叠术的历史，使用免疫抑制剂，后续行动被抽象出来。
结果：研究人群包括3466例BE患者，其中115例患有SOT（肺35，肝34，肾32，心脏14和胰腺2），704例接受慢性免疫抑制剂但无SOT病史。在5.1年的中位随访期间，三组之间的年度进展风险没有差异（SOT=0.61％，没有SOT，但在免疫抑制剂=0.82%，无SOT/无免疫抑制剂=0.94%，p=0.72）。在多变量分析中，免疫抑制剂的使用(比值比(OR)1.38,95%置信区间(CI)1.04~1.82,p=0.025),而SOT(OR0.39,95CI0.15~1.01,p=0.053)与BE患者肿瘤进展无关.
结论：免疫抑制是BE进展为HGD/EAC的危险因素。因此,需要考虑密切监测慢性免疫抑制剂的BE患者.
方法：这是2000年1月至2022年8月在克利夫兰诊所和附属医院就诊的BE患者的回顾性队列研究。人口统计,内窥镜和组织学发现，SOT和胃底折叠术的历史，使用免疫抑制剂，后续行动被抽象出来。
结果：研究人群包括3466例BE患者，其中115例患有SOT（肺35，肝34，肾32，心脏14和胰腺2），704例接受慢性免疫抑制剂但无SOT病史。在5.1年的中位随访期间，三组之间的年度进展风险没有差异（SOT=0.61％，没有SOT，但在免疫抑制剂=0.82%，无SOT/无免疫抑制剂=0.94%，p=0.72）。在多变量分析中，免疫抑制剂的使用(比值比(OR)1.38,95%置信区间(CI)1.04~1.82,p=0.025),而SOT(OR0.39,95CI0.15~1.01,p=0.053)与BE患者肿瘤进展无关.
结论：免疫抑制是BE进展为HGD/EAC的危险因素。因此,需要考虑密切监测慢性免疫抑制剂的BE患者.
