| Purpose: To investigate the clinical characteristics of gastric mucosal lesions and de novo gastric malignancy in liver transplant(LT)recipients,and we aimed to evaluate the risk factors for gastric epithelial precancerous congditions and the risk of de novo gastric malignancy in LT recipients,in order to provide clinical basis for the value of gastroscopy in LT population.Methods: This retrospective study included 157 LT recipients who underwent upper endoscopic examinations from January,2018 to October,2021 in our center.Patients in an age-and gender-matched screening population(n=314)were enrolled as controls at a ratio of 1:2 with case-control matching.To analysis the incidence of gastric epithelial precancerous congditions and lesions.According to the pathological results of gastric mucosa,LT recipients with gastric mucosal atrophy(GA)and intestinal metaplasia(IM)were divided as Chronic atrophic gastritis(CAG)group,and the remaining was no-CAG group,which explored the risk factors for CAG in LT recipients.Furthermore,we reviewed the clinical information of LT who confirmed by pathology as gastric malignancy,and initially explored the risk of de novo gastric malignancy in LT recipients by Kaplan-Meier survival analysis.Results: 1.CAG were common gastric mucosal lesions in LT recipients,GA and IM were 43.9%,40.1%,respectively,the prevalence of gastric epithelial precancerous congditions and gastric malignancy were 1.3%(2/157),3.8%(6/157),2 gastric epithelial precancerous congditions were low-grade intraepithelial neoplasia.The interval between LT and endoscopic examination was 6-91 months(median 23.8 months),there was no correlation between the interval time and the prevalence of gastric mucosal lesions.Compared with the control subjects,gastric malignancy(3.8% vs 0.6%,P<0.05),bile regurgitation(13.4% vs 5.7%,P<0.05),and reflux esophagitis(12.7% vs 6.4%,P<0.05)were significantly more frequent in LT patients,but H pylori infection was significantly more uncommon in LT patients(17/157;10.8%)than in control subjects(110/314;35%)(P<0.001).The incidence of GA,IM,gastric polyps,gastric ulcer,duodenal ulcers,and duodenal inflammation was similar between the two groups.According to CAG and no-CAG competing risks regression multivariate analysis,recipient age,smoking history,alcohol history,time of cirrhosis,tumor family history,H pylori infection were risk factors for post-LT CAG,and the independent risk factor of CAG were time of cirrhosis(OR=1.11,95% CI 1.02～1.21)and H pylori infectiond(OR=5.55,95% CI 1.46～21.08).2.Six LT patients of 157 developed de novo gastric malignancy in this study,The mean age at the time of gastric cancer diagnosis was 53.50±8.12(44-63)years mean time interval between liver transplantation and diagnosis of gastric cancer was 34.34±5.84(16-53)months,The standard incidence ratio of gastric cancer in these patients was 468 per 100000 persons.The probability to develop de novo malignancy after LT was 0% at 1 year,1.4% at 3 years,6.4% at 5 years,and 6.4% at 8 years.De novo malignancy was the risk factor affecting the long-term survival of LT patients(P=0.002),the death risk of LT patients with gastric malignany increased by 8.75 times compared to LT patients with no gastric malignany(P=0.01,95% CI 1.70～45.31).Conclusions:For liver transplant patients in our center,the posttransplant incidence of de novo gastric malignancy was significantly higher than the general population,and gastric cancer increased the death risk of liver transplant patients;The most common gastric mucosal lesions of the liver transplantation are gastric epithelial precancerous congditions,include GA(43.9% vs 37.9%)and IM(40.1% vs37.3%),but H.pylori infection is significantly lower than that of the general population;Risk factors for CAG among liver transplant patients include age,smoking history,alcohol history,time of cirrhosis,tumor family history,H pylori infection,and time of cirrhosis and H pylori infection were independent risk factors. |
PDF Full Text Request