Safety of Pre-Cardiac Transplant Screening Colonoscopy in Patients with Severe Heart Failure: A Single Center Retrospective Study

Safety of Pre-Cardiac Transplant Screening Colonoscopy in Patients with Severe Heart Failure: A Single Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety of Pre-Cardiac Transplant Screening Colonoscopy in Patients with Severe Heart Failure: A Single Center Retrospective Study Noor Hassan, Mir Zulqarnain, Chase Branstetter, Ifrah Fatima, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6621989/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Comprehensive pre-cardiac transplant evaluation, including routine colorectal cancer (CRC) screening, is vital for optimal organ allocation. Despite the routine use of colonoscopy, data on its risks and outcomes in patients with severe heart failure (HF) undergoing evaluation are limited. We aimed to evaluate risks and clinical outcomes of pre-cardiac transplant screening by comparing colonoscopy safety between patients with severe and nonsevere HF. Methods: We retrospectively reviewed charts of patients admitted for cardiac transplant evaluation at Saint Luke’s Hospital in Kansas City, Missouri, between April 2014 to August 2023. Patients were divided into two cohorts based on ejection fraction (EF): severe HF (EF < 30%) and non-severe HF (EF ≥ 30%). Demographics and clinical outcomes were compared using descriptive statistics and chi-square tests, with a p-value < 0.05 considered statistically significant. Results: Among 322 patients, 228 had EF < 30% and 94 had EF ≥ 30%. Adenoma detection rate was 37.1% in the EF ≥ 30% group and 26.6% in the EF < 30% group. High-grade lesions were detected in 1.8% of the EF ≥ 30% group and 1.1% of the EF < 30% group, with CRC found in 1.1% of the EF < 30% group and none in the EF ≥ 30% group. Statistical analysis showed no significant differences in adenoma detection (p = 0.08), high-grade lesions (p = 0.65), or CRC incidence (p = 0.92) between the groups. Adverse clinical outcomes such as bleeding, perforation, arrhythmia, hypotension, hypoxia, and respiratory failure were similar in both cohorts (p > 0.05 for all). Conclusions: The risks of screening colonoscopy preceding cardiac transplantation are similar between patients with EF ≥ 30% and EF < 30%. Safety outcomes and detection rates remain comparable regardless of EF status, supporting colonoscopy as a valuable screening tool in these patients. colonoscopy cardiac transplantation colorectal cancer Figures Figure 1 Background With the advancement in cardiovascular disease management and an aging global population, the prevalence of chronic diseases has risen significantly. In line with this change, there has been a marked increase in the incidence of heart failure cases over the last few decades. ( 1 ) According to the National Health and Nutrition Examination Survey, the prevalence of heart failure among adults in the United States increased from 5.7 million between 2009–2012 to 6.2 million between 2013–2016. Projections estimate a 46% rise in prevalence by 2030. This trend is also observed globally, with heart failure cases expected to rise substantially in the coming years. ( 2 ) Patients with end-stage heart failure, characterized by symptoms that are “disabling for daily life, refractory to all therapies, and with high mortality,” generally require advanced therapy. ( 3 ) Cardiac transplantation is known to be the optimal treatment for irreversible and severely advanced heart failure (HF). ( 3 , 4 ) The global shortage of donor organs necessitates stringent evaluation criteria to ensure the best post-transplant outcomes. A critical consideration in the evaluation process is the presence of pre-transplant malignancies. Pre-transplant malignancy is linked to decreased survival, and active malignancy, other than melanoma, is a contraindication for transplantation. ( 5 ) In a study published in the Journal of the American College of Cardiology, the prevalence of pre-transplant malignancies among cardiac transplant candidates was noted to be approximately 10%, with colorectal cancer being one of the most common. ( 6 ) Colonoscopy is the primary modality for diagnosing and treating various colorectal conditions, including advanced polyps and cancer. Although complications from colonoscopy are rare, especially in average-risk individuals, they remain a concern in patients with complex medical histories or comorbidities. A systematic review of 12 studies, including 57,742 colonoscopies for average risk screening, reported an overall serious adverse event rate of 2.8 per 1000 procedures. ( 7 , 8 ) Studies have examined colorectal complications following cardiac transplantation and the incidence of adenoma detection both before and after the procedure ( 9 , 10 , 11 ), underscoring the importance of colorectal cancer screening in cardiac transplant recipients. Despite this, there is a notable lack of data on the risks and outcomes associated with screening colonoscopies in this patient population. This study aims to evaluate the risks and clinical outcomes associated with pre-cardiac transplant screening colonoscopy in patients with severe heart failure. Methods Study Design: We completed a retrospective cohort study of patients undergoing colonoscopy as part of their pre-cardiac transplant evaluation. This study was conducted in a single tertiary transplant center using data from charts between April 2014 to August 2023. Patient demographics and clinical outcomes data were abstracted from the electronic medical record after Institutional Review Board approval. Study Sample: Patients were assigned to two cohorts based on ejection fraction (EF): severe heart failure (EF < 30%) and non-severe heart failure (EF ≥ 30%) during the time of colonoscopy. The EF cutoff of 30% was chosen based on literature classifying an EF < 30% as severely reduced. ( 12 , 13 ) All patients underwent colonoscopy in the inpatient setting. Medications around the procedure, including anticoagulants, antiplatelets, infusions, and sedation medications, were also recorded based on chart review. Statistical analysis: We conducted descriptive statistics, including chi-square tests, to compare the outcomes between the two groups. A p-value less than 0.05 was considered statistically significant. Results Our cohort included 322 patients (20% female, mean age: 56 ± 4.5 years) who underwent pre-transplant screening colonoscopy (n = 228 in EF < 30%, n = 94 in EF ≥ 30%) over a nine-year period. In the EF < 30% group (n = 230, 18.8% female, median age 57.5), previous medical history included history of arrhythmia (64%), obstructive sleep apnea (OSA) (37%), pulmonary hypertension (pHTN) (17%), and Chronic Obstructive Pulmonary Disease (COPD) or asthma (20%). The total number of patients with current use of antiplatelet or anticoagulant was 73.9%; no patients were on triple therapy; some patients were on both anticoagulant and antiplatelet agent (18.7%); others were on anticoagulation (AC) alone (12.6%), dual antiplatelet therapy (DAPT) (8.7%), or antiplatelet monotherapy (33.9%). With regards to sedating agents, most patients received propofol alone or propofol with additional agents such as fentanyl or midazolam. Less commonly, etomidate and ketamine were utilized with propofol. Only 7 patients did not receive propofol as part of their sedation in this cohort. In the EF ≥ 30% group (n = 92, 25% female, median age 37.5, average age 43.5), previous medical history included history of arrhythmia (48%), OSA (46%), pHTN (17%), COPD or asthma (22%), and current use of either antiplatelet or anticoagulant (80%). Subdivided, one patient was on triple therapy; some were on both anticoagulant and antiplatelet (14.1%) agents; and others were on AC alone (13%), DAPT (12%), and antiplatelet monotherapy (40.2%). Only 1 patient did not receive propofol as a sedative in this cohort. In the EF ≥ 30 group, adenoma detection rate was 37.1% of cases, with high-grade lesions detected in 1.8%, and no findings of CRC. Notably, the median age was 20 years younger in this cohort compared to the severe heart failure group. In the EF < 30 group, comparable rates were observed, with an adenoma detection rate of 26.6%, high-grade lesions in 1.1%, and CRC in 1.1%. Statistical analyses revealed no significant differences in adenoma detection rate (p = 0.08), high-grade lesions (p = 0.65), or CRC incidence (p = 0.92) between the two groups. Concerning adverse clinical outcomes, a comprehensive analysis of secondary adverse clinical outcomes, including bleeding, perforation, arrhythmia, myocardial infarction, stroke, hypotension, hypoxia, and respiratory failure, was performed. No statistically significant differences were observed in adverse clinical outcomes between the EF ≥ 30 and EF 0.05 for all). This data is described in Table 1 and Fig. 1 . Approximately 1/3 of patients in both groups had transient hypotension documented during colonoscopy. Re-hospitalization rate was also monitored. We found that only 2 of the 322 patients (< 1%) required rehospitalization within 30 days, and both had an ejection fraction of < 30%. Neither case was thought secondary to endoscopy. The first readmission was for renal failure 11 days after endoscopy and was attributed to cardiorenal syndrome. The second was for right ventricular dysfunction after left ventricular assist device (LVAD) placement. No patients with an ejection fraction ≥ 30% required rehospitalization. We used descriptive statistics to compare the incidence of adverse events between our patient cohort (n = 322) and a larger observational cohort of average-risk patients who underwent screening colonoscopy (n = 78,831). ( 14 ) This data is described in Table 2 . In the average risk group, perforation occurred in 48 patients (0.06%), bleeding in 203 (0.26%), arrhythmia in 4 (0.005%), cerebrovascular accident (CVA) in 2 (0.0025%), and hypoxia in 2 (0.0025%). In contrast, among our heart failure participants being screened for transplant, there were no cases of perforation (0%), bleeding occurred in 2 patients (0.62%), arrhythmia in 27 (8.38%), CVA in 3 (0.93%), and hypoxia in 21 (6.52%). Five episodes of hypoxia were noted in the EF ≥ 30% group, and sixteen episodes were noted in the EF 2 L of oxygen during the procedure to titrate SpO2 to > 92%. Hypoxic events were corrected by routine supplemental oxygen and did not require abortion of endoscopy. Myocardial infarction (MI) and CVA was reported as any event within 30 days of endoscopy regardless of presumed cause. Table 2 adverse events (AE) related to colonoscopy. Serious AE No. of pts with event Average Risk n(%) No. of pts with event Heart Failure n(%) Total # = 78,831 Total # = 322 Perforation 48 (0.06) 0 (0) Bleeding 203 (0.26) 2 (0.62) Arrhythmia 4 (0.005) 27 (8.38) CVA 2 (0.0025) 3 (0.93) Hypoxia 2 (0.0025) 21 (6.52) Discussion Organ transplant recipients face a significantly higher risk of colorectal cancer (CRC) compared to the general population and experience a higher mortality rate following a CRC diagnosis. ( 15 ) Various factors have been proposed to explain this increased risk. Perhaps the most cited explanation is the potential role of post-transplant immunosuppressive medications in contributing to the accelerated progression of CRC. Christenson et al. found that CRC in solid organ transplant recipients is associated with a higher incidence of PIK3CA mutations and mismatch repair-deficient (MMRd) disease, highlighting the link between immunosuppressants and CRC. ( 16 ) Additionally, a large study by Safaeian et al. identified an association between pre-existing medical conditions, such as cystic fibrosis, and an elevated risk of CRC in transplant recipients. Their study also revealed that the risk of CRC peaks around eight years post-transplant, potentially due to long-term immunosuppression. These findings support the importance of screening colonoscopies for patients undergoing cardiac transplant evaluation. ( 17 ) Given the heightened risk for CRC, detecting and removing any adenomas before transplantation is essential. For the same reason, these patients should remain diligent with regular CRC screening after transplantation. Colonoscopy is widely used for diagnosing and treating gastrointestinal conditions and for screening of colorectal neoplasms. Although serious complications of colonoscopy are uncommon, they may include cardiopulmonary complications, perforation, hemorrhage, and infection. ( 18 ) Apart from these acute complications, there is also an increased risk of cardiovascular events in the 30-day post-procedure period for any patient undergoing colonoscopy. A 2009 study among Medicare beneficiaries highlighted an increased risk on cardiovascular complications (including MI, angina, arrhythmias, congestive heart failure exacerbation, cardiac/respiratory arrest, syncope, hypotension, and shock), particularly in patients aged 75 or older undergoing colonoscopy with comorbidities such as diabetes, stroke, congestive HF, COPD, or atrial fibrillation. ( 18 ) Similarly, a 2020 study by Causada-Calo et al confirmed the higher risk of adverse events during colonoscopy among patients 75 and older. ( 19 ) In contrast, our heart failure patient cohorts had a cumulative mean age of 56. The lower average age of our study population reflects the national data from the Organ Procurement and Transplantation Network, which demonstrates that the majority of cardiac transplant recipients to date were between the ages of 50 and 64, followed by 35 to 49 years old. ( 20 ). As such, there is an anticipated difference in safety profile, but the existing data regarding endoscopy safety in patients with heart failure is mixed. A Spanish study by Méndez-Bailón et. al. examining in-hospital mortality among 72,000 patients hospitalized for heart failure exacerbations who underwent colonoscopy found that colonoscopies were associated with lower in-hospital mortality rates. ( 21 ) However, the study did not stratify the severity of heart failure, and it did not subdivide or delineate the indication for colonoscopy. In contrast, a study by Abu et. al found that patients with severe heart failure were at increased risk for mortality and complications following endoscopic procedures. However, this study had a smaller sample size of 207 patients and included both esophagogastroduodenoscopy and colonoscopy in the analysis. ( 22 ) Study differences and limited data can make it difficult to confidently extrapolate the safety profiles of colonoscopy in more niche populations such as those presenting for pre-transplant colonoscopy, especially in those patients presenting with severe heart failure. Concerning safety profiles in our study, there were increased common minor adverse events noted during colonoscopy among both cohorts compared to the general population. This was especially noted as an increased frequency of hypoxia and arrhythmia (see Table 1 ). The definitions of hypoxia and arrhythmia in the study were broad including all instances of hypoxia (irrespective of underlying lung disease) and arrhythmia. The definition of arrhythmia included sinus tachycardia, premature ventricular contractions (PVCs), and atrial fibrillation among others, rather than only arrhythmias with serious negative patient outcomes. No statistically significant differences in adverse clinical outcomes were noted between our cohorts (EF ≥ 30 and EF 0.05 for all). In practice, our findings support that clinicians can proceed with colonoscopy in the pre-transplant evaluation of patients with severe HF. However, providers should be aware that colonoscopy in patients undergoing pre-cardiac transplant evaluation have increased rates of both minor and major adverse outcomes compared to the general population. Certain precautions should be taken to mitigate the inherent risks associated with performing invasive procedures in this high-risk group. Patients with advanced heart failure undergoing transplant evaluation should undergo a thorough cardiovascular assessment before the colonoscopy to ensure optimal patient condition for the procedure. This may involve adjusting medications, optimizing fluid status, and managing comorbid conditions. During the procedure, continuous monitoring of vital signs is essential to detect and address any immediate complications, such as transient hypotension, hypoxia, or arrhythmias, which were the most common findings among our patients. The use of sedation should be carefully managed to avoid exacerbating cardiovascular instability, emphasizing the importance of collaboration with anesthesiologists in these cases. Diligent post-procedural monitoring should be implemented to promptly identify and manage any delayed complications. Our findings suggest that colonoscopy be included as a routine part of the pre-cardiac transplant evaluation protocol for all patients regardless of the severity of their heart failure. This not only ensures adherence to comprehensive cancer screening guidelines but also supports optimal allocation of donor organs by identifying and addressing potential malignancies before transplantation, especially considering that the adenoma detection rate (ADR) and the detection of high-grade lesions in our cohort are consistent with benchmarks established for average-risk populations. The ADR in our study was 37.1% for the EF ≥ 30% group and 26.6% for the EF < 30% group, which falls within the range reported in general screening populations. According to Rex et al, the task force recommends a minimum target for overall ADR of 25% in mixed gender screening. ( 23 ) This suggests that the severity of heart failure also does not significantly impair the effectiveness of colonoscopy in detecting colorectal neoplasms. Future research should focus on prospective studies to explore factors that influence the safety and effectiveness of colonoscopy in patients with severe heart failure. Specifically, studies may investigate the impact of different sedation protocols, the role of pre-procedural optimization strategies, and the long-term outcomes of patients who undergo colonoscopy as part of their pre-transplant evaluation, and the utility of non-invasive, non-endoscopic methods of colorectal cancer detection as these technologies advance. Limitations: While our study provides valuable insights, it is important to recognize several limitations. The retrospective design of our study inherently limits control over potential confounding variables. Although we employed statistical methods to adjust for known confounders, unmeasured variables may still influence outcomes. In addition to this, our cohort was limited to a single hospital and therefore may not be generalizable to the average population. The sample size, while adequate for detecting differences in major outcomes, may not be large enough to identify less common adverse events. Additionally, the patients were not directly compared to control patients with normal cardiac function, which may limit the interpretation of the results. Data was primarily collected by resident physicians and gastroenterology fellows. Additional limitations include the limited variance in sedation that our cohorts received, as all but 8 patients received propofol. A direct comparison between adverse cardiopulmonary events in patients receiving different types of sedating agents was not achievable in this study. The inclusion criteria for counting an arrhythmia as an adverse event was very broad, including less clinically significant rhythms such sinus tachycardia and PVCs. While noteworthy, these did not not translate to negative patient outcomes. Having such broad inclusion criteria, while comprehensive, made direct comparison of safety between studies with more severe and stringent definitions of adverse arrhythmia difficult. Similarly, the inclusion criteria of hypoxic episodes (> 2L of oxygen required to keep the patient’s O2 saturation above 92%) also made it harder to compare with studies that included only more severe adverse respiratory events. Conclusion Colorectal cancer screening with colonoscopy is a valuable tool in the pre-transplant evaluation of patients with severe heart failure. Our study provides data on the safety profiles of pre-transplant colonoscopy comparing severe (EF < 30%) and non-severe HF (EF ≥ 30%) cohorts as well as adenoma and colorectal cancer detection rates between the two cohorts. The results suggest the risks of adverse clinical outcomes are comparable between patients with severe and non-severe heart failure. In addition to this, severity of heart failure does not appear to significantly impair the effectiveness of colonoscopy in detecting colorectal neoplasms. Transient hypotension, hypoxia, and arrhythmia were common adverse events associated with pre-transplant colonoscopy in both heart failure cohorts. Hospital readmission, myocardial infarction, and CVA were noted to have occurred within 30 days of colonoscopy, and while reported for comprehensiveness, were not thought to have been caused by endoscopy. These findings support the relative safety of colonoscopy for colorectal cancer screening, ensuring comprehensive evaluation and optimal preparation for cardiac transplantation. However, these procedures should be performed in centers that routinely manage the specific challenges inherent to these high-risk patients. Abbreviations CRC Colorectal Cancer HF Heart Failure EF Ejection Fraction OSA Obstructive Sleep Apnea pHTN Pulmonary Hypertension COPD Chronic Obstructive Pulmonary Disease DAPT Dual Antiplatelet Therapy AC Anticoagulation LVAD Left Ventricular Assist Device CVA Cerebrovascular Accident MI Myocardial Infarction MMRd Mutations and Mismatch Repair-Deficient Disease ADR Adenoma Detection Rate Declarations Ethics and Consent Statement: This is a retrospective study of already available data, therefore, it does not involve active human participants and/or animals. Hence, formal consent and informed consent were not applicable. IRB approval was obtained before chart review. Consent for Publication: Not applicable Data Availability: The dataset analyzed during this study is available from the corresponding author upon request. Competing Interests: The authors do not declare any conflicts of interest. Funding: None of the authors has any financial disclosures. No funding was used for this study. Author contributions: Conception of study idea: Noor Hassan, MD; Mir Zulqarnain, DO; Wendell Clarkston, MD Data collection, drafting of initial manuscript, editing: Noor Hassan, MD; Mir Zulqarnain, DO; Ifrah Fatima, MD; Islam Mohamed, MD; Vinay Jahagirdar, MD; Jagadish Koyi, MD; Ameen Awad, MD; Misha Gautam, MD; Abbas Bader; Sruthi Sripada; Thomas Cunningham, MD; Wendell Clarkston, MD Data curation, analysis: Noor Hassan, MD; Mir Zulqarnain, DO; Saqr Alsakarneh, MD; Mohamed Ahmed, MD Reviewing, editing for intellectual content, and final approval of manuscript: All authors References M. C. (2002). Cardiac transplantation. Heart, 87 (2), 177–84. https://doi.org/10.1136/heart.87.2.177 Murphy SP, Ibrahim NE, Januzzi JL. Heart failure with reduced ejection fraction. JAMA. 2020;324(5):488. https://doi.org/10.1001/jama.2020.10262 . Crespo-Leiro MG, Barge-Caballero E. Advanced heart failure. Heart Fail Clin. 2021;17(4):533–45. https://doi.org/10.1016/j.hfc.2021.06.002 . Lee SJ, Kim KH, Hong SK, Hankins S. Evaluation of a heart transplant candidate. Curr Cardiol Rep. 2017;19(12). https://doi.org/10.1007/s11886-017-0934-y . Fernandez-Vivancos C et al. Long-term outcome in heart transplant patients with pretransplant malignancies. Transplant Proc. 2010;42(8):3006–10. Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transpl. 2010;29(8):914–56. 10.1016/j.healun.2010.05.034 . Whitlock EP, Lin JS, Liles E et al. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Int Med. 2008; 149 ([see comment][summary for patients in Ann Intern Med 2008;149:I-44; PMID: 18838719 Epub 2008 Oct 6]): 638–658. Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52. https://doi.org/10.1016/j.gie.2011.07.025 . Goldberg HJ, Hertz MI, Ricciardi R, Madoff RD, Baxter NN, Bullard KM. Colon and rectal complications after heart and Lung Transplantation. J Am Coll Surg. 2006;202(1):55–61. https://doi.org/10.1016/j.jamcollsurg.2005.08.025 . Rodriguez-Larrain JM, Ziebert JJ, Kfoury AG, Kuwada S, Taylor DO, Renlund DG. Incidence of adenomatous colorectal polyps in cardiac transplant recipients. Transplantation. 1997;64(3):528–30. https://doi.org/10.1097/00007890-199708150-00025 . Daruwala C, Krevsky B. Prevalence of colorectal polyps in potential cardiac transplant recipients. Gastrointest Endosc. 2005;61(5). https://doi.org/10.1016/s0016-5107(05)01329-5 . Healy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS. Perioperative outcome and long-term mortality for heart failure patients undergoing intermediate‐ and high‐risk noncardiac surgery: Impact of left ventricular ejection fraction. Congestive Heart Fail. 2010;16(2):45–9. 10.1111/j.1751-7133.2009.00130.x . Lerman BJ, Popat RA, Assimes TL, Heidenreich PA, Wren SM. Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA. 2019;321(6):572. 10.1001/jama.2019.0156 . Tomaszewski M, Sanders D, Enns R, et al. Risks associated with colonoscopy in a population-based Colon Screening Program: An observational cohort study. CMAJ Open. 2021;9(4). 10.9778/cmajo.20200192 . Prenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant. 2017;17(11):2761–74. 10.1111/ajt.14340 . Christenson ES, Lee V, Wang H, Yarchoan M, De Jesus-Acosta A, Azad N, Gurakar A, Lin MT, Le DT, Brennan DC, Jaffee EM, Bever K. Solid Organ Transplantation Is Associated with an Increased Rate of Mismatch Repair Deficiency and PIK3CA Mutations in Colorectal Cancer. Curr Oncol. 2022;30(1):75–84. 10.3390/curroncol30010006 . PMID: 36661655; PMCID: PMC9858144. Safaeian M, Robbins HA, Berndt SI, Lynch CF, Fraumeni JF Jr, Engels EA. Risk of Colorectal Cancer After Solid Organ Transplantation in the United States. Am J Transpl. 2016;16(3):960–7. 10.1111/ajt.13549 . Epub 2016 Jan 5. PMID: 26731613; PMCID: PMC5218822. Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–57. W152. Causada-Calo N, Bishay K, Albashir S, Mazroui A, A., Armstrong D. Association between age and complications after outpatient colonoscopy. JAMA Netw Open. 2020;3(6). https://doi.org/10.1001/jamanetworkopen.2020.8958 . Transplants in the U.S. by Recipient Age. Organ Procure Transplantation https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# Méndez-Bailón M, Jiménez-García R, Muñoz-Rivas N, Hernández-Barrera V, de Miguel-Yanes JM, de Miguel-Díez J, Andrès E, Lorenzo-Villalba N, López-de-Andrés A. Trends and clinical impact of gastrointestinal endoscopic procedures on acute heart failure in Spain (2002–2017). J Clin Med. 2021;10(3):546. https://doi.org/10.3390/jcm10030546 . Abu Ghanimeh M, Albadarinb S, Kaddourah O, Alturkmani H, Abughanimeh O, Tahboub M, Derbas L, Clarkston W. Safety of Gastrointestinal Endoscopic Procedures in Patients with Severe Heart Failure. Am J Gastroenterol. 2017;11:S265–6. Douglas K, Rex. Key quality indicators in colonoscopy, Gastroenterology Report , Volume 11, 2023, goad009. https://doi-org.proxy.library.umkc.edu/10.1093/gastro/goad009 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6621989","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466884995,"identity":"9c7b2d0c-322f-4185-bd99-59d1c7877331","order_by":0,"name":"Noor Hassan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYJACZih1gIHhAIiRQLQWtgSStfAYEKfFnL352OeCmjp7/tk936RunLFj4GfPMcCrxbLnWPLsGccOJ864c3abdM6NZAbJnjf4tRjcyDFm5mE7kMBwIxeo5cMBkAgxWv7V2cvfyHkG1mJPlBbeNmbGDTdy2IAOA9oiQUjLmWPJzLx9hxM33kgzts45k8wjceZZAX4tx5sPM/N8q7OXu5H88HbOMTs5/vbkDXi1YAAe0pSPglEwCkbBKMAKAEwnR2H5YJaSAAAAAElFTkSuQmCC","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Noor","middleName":"","lastName":"Hassan","suffix":""},{"id":466884996,"identity":"fd31678b-3336-463d-9a49-a8287f55a568","order_by":1,"name":"Mir Zulqarnain","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mir","middleName":"","lastName":"Zulqarnain","suffix":""},{"id":466884997,"identity":"d98f7b17-5404-4989-9774-5bc786e0cbf8","order_by":2,"name":"Chase Branstetter","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chase","middleName":"","lastName":"Branstetter","suffix":""},{"id":466884998,"identity":"1d220f45-37c3-4362-ba1f-8265322cfeb5","order_by":3,"name":"Ifrah Fatima","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ifrah","middleName":"","lastName":"Fatima","suffix":""},{"id":466884999,"identity":"31a715e6-0c68-4b3e-839d-7407e45f2eb4","order_by":4,"name":"Islam Mohamed","email":"","orcid":"","institution":"University of Missouri","correspondingAuthor":false,"prefix":"","firstName":"Islam","middleName":"","lastName":"Mohamed","suffix":""},{"id":466885000,"identity":"3fc3669e-ec3e-4603-9685-c01ab110cadb","order_by":5,"name":"Vinay Jahagirdar","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Vinay","middleName":"","lastName":"Jahagirdar","suffix":""},{"id":466885001,"identity":"62e8ff02-b921-41a7-815c-d9e14ea12587","order_by":6,"name":"Jagadish Koyi","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jagadish","middleName":"","lastName":"Koyi","suffix":""},{"id":466885002,"identity":"8ace66d4-022b-4ebb-9a09-65c5d37f757a","order_by":7,"name":"Saqr Alsakarneh","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Saqr","middleName":"","lastName":"Alsakarneh","suffix":""},{"id":466885003,"identity":"34ad5d74-4bd4-4694-a6a9-816309669f91","order_by":8,"name":"Ameen Awad","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ameen","middleName":"","lastName":"Awad","suffix":""},{"id":466885004,"identity":"97d20b9a-7e29-4317-b02f-52a057f1dc23","order_by":9,"name":"Misha Gautam","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Misha","middleName":"","lastName":"Gautam","suffix":""},{"id":466885005,"identity":"acb6f5c8-6595-4986-8113-008345715701","order_by":10,"name":"Abbas Bader","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Abbas","middleName":"","lastName":"Bader","suffix":""},{"id":466885006,"identity":"ac57d39b-012b-4ca8-ae2f-8ffedd450667","order_by":11,"name":"Sruthi Sripada","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sruthi","middleName":"","lastName":"Sripada","suffix":""},{"id":466885007,"identity":"77050c00-8913-42a7-8b25-60431daffc2f","order_by":12,"name":"Mohamed Ahmed","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Ahmed","suffix":""},{"id":466885008,"identity":"07fc45b7-f96d-4ba6-bead-175d2a0a2d61","order_by":13,"name":"Adel Muhanna","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Adel","middleName":"","lastName":"Muhanna","suffix":""},{"id":466885009,"identity":"f9b4aa1a-edf8-4082-885d-631bee449f2a","order_by":14,"name":"Thomas Cunningham","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Cunningham","suffix":""},{"id":466885010,"identity":"f69a95ce-37aa-404b-8996-04f79b611a27","order_by":15,"name":"Wendell Clarkston","email":"","orcid":"","institution":"University of Missouri Kansas City School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wendell","middleName":"","lastName":"Clarkston","suffix":""}],"badges":[],"createdAt":"2025-05-08 15:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6621989/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6621989/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84323813,"identity":"af1c0995-3888-477a-b557-c8b4969fd574","added_by":"auto","created_at":"2025-06-10 14:46:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39385,"visible":true,"origin":"","legend":"\u003cp\u003eRisks and clinical outcomes of pre-cardiac transplant screening colonoscopy in patients with severe heart failure.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6621989/v1/9bc80c6d0be5898696b06b29.png"},{"id":98626136,"identity":"6228e139-4659-4d0a-a4c3-06839c7293e6","added_by":"auto","created_at":"2025-12-19 17:09:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":758412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6621989/v1/2b8d2d1d-760b-42ad-9ba7-6ba67853743f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety of Pre-Cardiac Transplant Screening Colonoscopy in Patients with Severe Heart Failure: A Single Center Retrospective Study ","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the advancement in cardiovascular disease management and an aging global population, the prevalence of chronic diseases has risen significantly. In line with this change, there has been a marked increase in the incidence of heart failure cases over the last few decades. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) According to the National Health and Nutrition Examination Survey, the prevalence of heart failure among adults in the United States increased from 5.7\u0026nbsp;million between 2009\u0026ndash;2012 to 6.2\u0026nbsp;million between 2013\u0026ndash;2016. Projections estimate a 46% rise in prevalence by 2030. This trend is also observed globally, with heart failure cases expected to rise substantially in the coming years. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients with end-stage heart failure, characterized by symptoms that are \u0026ldquo;disabling for daily life, refractory to all therapies, and with high mortality,\u0026rdquo; generally require advanced therapy. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCardiac transplantation is known to be the optimal treatment for irreversible and severely advanced heart failure (HF). (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The global shortage of donor organs necessitates stringent evaluation criteria to ensure the best post-transplant outcomes. A critical consideration in the evaluation process is the presence of pre-transplant malignancies. Pre-transplant malignancy is linked to decreased survival, and active malignancy, other than melanoma, is a contraindication for transplantation. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) In a study published in the Journal of the American College of Cardiology, the prevalence of pre-transplant malignancies among cardiac transplant candidates was noted to be approximately 10%, with colorectal cancer being one of the most common. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Colonoscopy is the primary modality for diagnosing and treating various colorectal conditions, including advanced polyps and cancer. Although complications from colonoscopy are rare, especially in average-risk individuals, they remain a concern in patients with complex medical histories or comorbidities. A systematic review of 12 studies, including 57,742 colonoscopies for average risk screening, reported an overall serious adverse event rate of 2.8 per 1000 procedures. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eStudies have examined colorectal complications following cardiac transplantation and the incidence of adenoma detection both before and after the procedure (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), underscoring the importance of colorectal cancer screening in cardiac transplant recipients. Despite this, there is a notable lack of data on the risks and outcomes associated with screening colonoscopies in this patient population. This study aims to evaluate the risks and clinical outcomes associated with pre-cardiac transplant screening colonoscopy in patients with severe heart failure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eWe completed a retrospective cohort study of patients undergoing colonoscopy as part of their pre-cardiac transplant evaluation. This study was conducted in a single tertiary transplant center using data from charts between April 2014 to August 2023. Patient demographics and clinical outcomes data were abstracted from the electronic medical record after Institutional Review Board approval.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Sample:\u003c/h3\u003e\n\u003cp\u003ePatients were assigned to two cohorts based on ejection fraction (EF): severe heart failure (EF\u0026thinsp;\u0026lt;\u0026thinsp;30%) and non-severe heart failure (EF\u0026thinsp;\u0026ge;\u0026thinsp;30%) during the time of colonoscopy. The EF cutoff of 30% was chosen based on literature classifying an EF\u0026thinsp;\u0026lt;\u0026thinsp;30% as severely reduced. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) All patients underwent colonoscopy in the inpatient setting. Medications around the procedure, including anticoagulants, antiplatelets, infusions, and sedation medications, were also recorded based on chart review.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eWe conducted descriptive statistics, including chi-square tests, to compare the outcomes between the two groups. A p-value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOur cohort included 322 patients (20% female, mean age: 56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 years) who underwent pre-transplant screening colonoscopy (n\u0026thinsp;=\u0026thinsp;228 in EF\u0026thinsp;\u0026lt;\u0026thinsp;30%, n\u0026thinsp;=\u0026thinsp;94 in EF\u0026thinsp;\u0026ge;\u0026thinsp;30%) over a nine-year period. In the EF\u0026thinsp;\u0026lt;\u0026thinsp;30% group (n\u0026thinsp;=\u0026thinsp;230, 18.8% female, median age 57.5), previous medical history included history of arrhythmia (64%), obstructive sleep apnea (OSA) (37%), pulmonary hypertension (pHTN) (17%), and Chronic Obstructive Pulmonary Disease (COPD) or asthma (20%). The total number of patients with current use of antiplatelet or anticoagulant was 73.9%; no patients were on triple therapy; some patients were on both anticoagulant and antiplatelet agent (18.7%); others were on anticoagulation (AC) alone (12.6%), dual antiplatelet therapy (DAPT) (8.7%), or antiplatelet monotherapy (33.9%). With regards to sedating agents, most patients received propofol alone or propofol with additional agents such as fentanyl or midazolam. Less commonly, etomidate and ketamine were utilized with propofol. Only 7 patients did not receive propofol as part of their sedation in this cohort.\u003c/p\u003e \u003cp\u003eIn the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group (n\u0026thinsp;=\u0026thinsp;92, 25% female, median age 37.5, average age 43.5), previous medical history included history of arrhythmia (48%), OSA (46%), pHTN (17%), COPD or asthma (22%), and current use of either antiplatelet or anticoagulant (80%). Subdivided, one patient was on triple therapy; some were on both anticoagulant and antiplatelet (14.1%) agents; and others were on AC alone (13%), DAPT (12%), and antiplatelet monotherapy (40.2%). Only 1 patient did not receive propofol as a sedative in this cohort.\u003c/p\u003e \u003cp\u003eIn the EF\u0026thinsp;\u0026ge;\u0026thinsp;30 group, adenoma detection rate was 37.1% of cases, with high-grade lesions detected in 1.8%, and no findings of CRC. Notably, the median age was 20 years younger in this cohort compared to the severe heart failure group. In the EF\u0026thinsp;\u0026lt;\u0026thinsp;30 group, comparable rates were observed, with an adenoma detection rate of 26.6%, high-grade lesions in 1.1%, and CRC in 1.1%. Statistical analyses revealed no significant differences in adenoma detection rate (p\u0026thinsp;=\u0026thinsp;0.08), high-grade lesions (p\u0026thinsp;=\u0026thinsp;0.65), or CRC incidence (p\u0026thinsp;=\u0026thinsp;0.92) between the two groups.\u003c/p\u003e \u003cp\u003eConcerning adverse clinical outcomes, a comprehensive analysis of secondary adverse clinical outcomes, including bleeding, perforation, arrhythmia, myocardial infarction, stroke, hypotension, hypoxia, and respiratory failure, was performed. No statistically significant differences were observed in adverse clinical outcomes between the EF\u0026thinsp;\u0026ge;\u0026thinsp;30 and EF\u0026thinsp;\u0026lt;\u0026thinsp;30 groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all). This data is described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Approximately 1/3 of patients in both groups had transient hypotension documented during colonoscopy. Re-hospitalization rate was also monitored. We found that only 2 of the 322 patients (\u0026lt;\u0026thinsp;1%) required rehospitalization within 30 days, and both had an ejection fraction of \u0026lt;\u0026thinsp;30%. Neither case was thought secondary to endoscopy. The first readmission was for renal failure 11 days after endoscopy and was attributed to cardiorenal syndrome. The second was for right ventricular dysfunction after left ventricular assist device (LVAD) placement. No patients with an ejection fraction\u0026thinsp;\u0026ge;\u0026thinsp;30% required rehospitalization.\u003c/p\u003e\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"666\" height=\"358\"\u003e\u003c/p\u003e\n\u003cp\u003eWe used descriptive statistics to compare the incidence of adverse events between our patient cohort (n\u0026thinsp;=\u0026thinsp;322) and a larger observational cohort of average-risk patients who underwent screening colonoscopy (n\u0026thinsp;=\u0026thinsp;78,831). (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) This data is described in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In the average risk group, perforation occurred in 48 patients (0.06%), bleeding in 203 (0.26%), arrhythmia in 4 (0.005%), cerebrovascular accident (CVA) in 2 (0.0025%), and hypoxia in 2 (0.0025%). In contrast, among our heart failure participants being screened for transplant, there were no cases of perforation (0%), bleeding occurred in 2 patients (0.62%), arrhythmia in 27 (8.38%), CVA in 3 (0.93%), and hypoxia in 21 (6.52%). Five episodes of hypoxia were noted in the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group, and sixteen episodes were noted in the EF\u0026thinsp;\u0026lt;\u0026thinsp;30%. Hypoxia was defined as requiring\u0026thinsp;\u0026gt;\u0026thinsp;2 L of oxygen during the procedure to titrate SpO2 to \u0026gt;\u0026thinsp;92%. Hypoxic events were corrected by routine supplemental oxygen and did not require abortion of endoscopy. Myocardial infarction (MI) and CVA was reported as any event within 30 days of endoscopy regardless of presumed cause.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eadverse events (AE) related to colonoscopy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerious AE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of pts with event\u003c/p\u003e \u003cp\u003eAverage Risk n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. of pts with event\u003c/p\u003e \u003cp\u003eHeart Failure n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal # = 78,831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal # = 322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrhythmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (8.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.0025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoxia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.0025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (6.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOrgan transplant recipients face a significantly higher risk of colorectal cancer (CRC) compared to the general population and experience a higher mortality rate following a CRC diagnosis. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Various factors have been proposed to explain this increased risk. Perhaps the most cited explanation is the potential role of post-transplant immunosuppressive medications in contributing to the accelerated progression of CRC. Christenson et al. found that CRC in solid organ transplant recipients is associated with a higher incidence of PIK3CA mutations and mismatch repair-deficient (MMRd) disease, highlighting the link between immunosuppressants and CRC. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Additionally, a large study by Safaeian et al. identified an association between pre-existing medical conditions, such as cystic fibrosis, and an elevated risk of CRC in transplant recipients. Their study also revealed that the risk of CRC peaks around eight years post-transplant, potentially due to long-term immunosuppression. These findings support the importance of screening colonoscopies for patients undergoing cardiac transplant evaluation. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Given the heightened risk for CRC, detecting and removing any adenomas before transplantation is essential. For the same reason, these patients should remain diligent with regular CRC screening after transplantation.\u003c/p\u003e \u003cp\u003eColonoscopy is widely used for diagnosing and treating gastrointestinal conditions and for screening of colorectal neoplasms. Although serious complications of colonoscopy are uncommon, they may include cardiopulmonary complications, perforation, hemorrhage, and infection. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Apart from these acute complications, there is also an increased risk of cardiovascular events in the 30-day post-procedure period for any patient undergoing colonoscopy.\u003c/p\u003e \u003cp\u003eA 2009 study among Medicare beneficiaries highlighted an increased risk on cardiovascular complications (including MI, angina, arrhythmias, congestive heart failure exacerbation, cardiac/respiratory arrest, syncope, hypotension, and shock), particularly in patients aged 75 or older undergoing colonoscopy with comorbidities such as diabetes, stroke, congestive HF, COPD, or atrial fibrillation. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Similarly, a 2020 study by Causada-Calo et al confirmed the higher risk of adverse events during colonoscopy among patients 75 and older. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) In contrast, our heart failure patient cohorts had a cumulative mean age of 56. The lower average age of our study population reflects the national data from the Organ Procurement and Transplantation Network, which demonstrates that the majority of cardiac transplant recipients to date were between the ages of 50 and 64, followed by 35 to 49 years old. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). As such, there is an anticipated difference in safety profile, but the existing data regarding endoscopy safety in patients with heart failure is mixed.\u003c/p\u003e \u003cp\u003eA Spanish study by M\u0026eacute;ndez-Bail\u0026oacute;n et. al. examining in-hospital mortality among 72,000 patients hospitalized for heart failure exacerbations who underwent colonoscopy found that colonoscopies were associated with lower in-hospital mortality rates. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) However, the study did not stratify the severity of heart failure, and it did not subdivide or delineate the indication for colonoscopy. In contrast, a study by Abu et. al found that patients with severe heart failure were at increased risk for mortality and complications following endoscopic procedures. However, this study had a smaller sample size of 207 patients and included both esophagogastroduodenoscopy and colonoscopy in the analysis. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Study differences and limited data can make it difficult to confidently extrapolate the safety profiles of colonoscopy in more niche populations such as those presenting for pre-transplant colonoscopy, especially in those patients presenting with severe heart failure.\u003c/p\u003e \u003cp\u003eConcerning safety profiles in our study, there were increased common minor adverse events noted during colonoscopy among both cohorts compared to the general population. This was especially noted as an increased frequency of hypoxia and arrhythmia (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The definitions of hypoxia and arrhythmia in the study were broad including all instances of hypoxia (irrespective of underlying lung disease) and arrhythmia. The definition of arrhythmia included sinus tachycardia, premature ventricular contractions (PVCs), and atrial fibrillation among others, rather than only arrhythmias with serious negative patient outcomes.\u003c/p\u003e \u003cp\u003eNo statistically significant differences in adverse clinical outcomes were noted between our cohorts (EF\u0026thinsp;\u0026ge;\u0026thinsp;30 and EF\u0026thinsp;\u0026lt;\u0026thinsp;30, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all). In practice, our findings support that clinicians can proceed with colonoscopy in the pre-transplant evaluation of patients with severe HF. However, providers should be aware that colonoscopy in patients undergoing pre-cardiac transplant evaluation have increased rates of both minor and major adverse outcomes compared to the general population. Certain precautions should be taken to mitigate the inherent risks associated with performing invasive procedures in this high-risk group.\u003c/p\u003e \u003cp\u003ePatients with advanced heart failure undergoing transplant evaluation should undergo a thorough cardiovascular assessment before the colonoscopy to ensure optimal patient condition for the procedure. This may involve adjusting medications, optimizing fluid status, and managing comorbid conditions. During the procedure, continuous monitoring of vital signs is essential to detect and address any immediate complications, such as transient hypotension, hypoxia, or arrhythmias, which were the most common findings among our patients. The use of sedation should be carefully managed to avoid exacerbating cardiovascular instability, emphasizing the importance of collaboration with anesthesiologists in these cases. Diligent post-procedural monitoring should be implemented to promptly identify and manage any delayed complications.\u003c/p\u003e \u003cp\u003eOur findings suggest that colonoscopy be included as a routine part of the pre-cardiac transplant evaluation protocol for all patients regardless of the severity of their heart failure. This not only ensures adherence to comprehensive cancer screening guidelines but also supports optimal allocation of donor organs by identifying and addressing potential malignancies before transplantation, especially considering that the adenoma detection rate (ADR) and the detection of high-grade lesions in our cohort are consistent with benchmarks established for average-risk populations.\u003c/p\u003e \u003cp\u003eThe ADR in our study was 37.1% for the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group and 26.6% for the EF\u0026thinsp;\u0026lt;\u0026thinsp;30% group, which falls within the range reported in general screening populations. According to Rex et al, the task force recommends a minimum target for overall ADR of 25% in mixed gender screening. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) This suggests that the severity of heart failure also does not significantly impair the effectiveness of colonoscopy in detecting colorectal neoplasms.\u003c/p\u003e \u003cp\u003eFuture research should focus on prospective studies to explore factors that influence the safety and effectiveness of colonoscopy in patients with severe heart failure. Specifically, studies may investigate the impact of different sedation protocols, the role of pre-procedural optimization strategies, and the long-term outcomes of patients who undergo colonoscopy as part of their pre-transplant evaluation, and the utility of non-invasive, non-endoscopic methods of colorectal cancer detection as these technologies advance.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eWhile our study provides valuable insights, it is important to recognize several limitations. The retrospective design of our study inherently limits control over potential confounding variables. Although we employed statistical methods to adjust for known confounders, unmeasured variables may still influence outcomes. In addition to this, our cohort was limited to a single hospital and therefore may not be generalizable to the average population. The sample size, while adequate for detecting differences in major outcomes, may not be large enough to identify less common adverse events. Additionally, the patients were not directly compared to control patients with normal cardiac function, which may limit the interpretation of the results. Data was primarily collected by resident physicians and gastroenterology fellows.\u003c/p\u003e \u003cp\u003eAdditional limitations include the limited variance in sedation that our cohorts received, as all but 8 patients received propofol. A direct comparison between adverse cardiopulmonary events in patients receiving different types of sedating agents was not achievable in this study. The inclusion criteria for counting an arrhythmia as an adverse event was very broad, including less clinically significant rhythms such sinus tachycardia and PVCs. While noteworthy, these did not not translate to negative patient outcomes. Having such broad inclusion criteria, while comprehensive, made direct comparison of safety between studies with more severe and stringent definitions of adverse arrhythmia difficult. Similarly, the inclusion criteria of hypoxic episodes (\u0026gt;\u0026thinsp;2L of oxygen required to keep the patient\u0026rsquo;s O2 saturation above 92%) also made it harder to compare with studies that included only more severe adverse respiratory events.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eColorectal cancer screening with colonoscopy is a valuable tool in the pre-transplant evaluation of patients with severe heart failure. Our study provides data on the safety profiles of pre-transplant colonoscopy comparing severe (EF\u0026thinsp;\u0026lt;\u0026thinsp;30%) and non-severe HF (EF\u0026thinsp;\u0026ge;\u0026thinsp;30%) cohorts as well as adenoma and colorectal cancer detection rates between the two cohorts. The results suggest the risks of adverse clinical outcomes are comparable between patients with severe and non-severe heart failure. In addition to this, severity of heart failure does not appear to significantly impair the effectiveness of colonoscopy in detecting colorectal neoplasms. Transient hypotension, hypoxia, and arrhythmia were common adverse events associated with pre-transplant colonoscopy in both heart failure cohorts. Hospital readmission, myocardial infarction, and CVA were noted to have occurred within 30 days of colonoscopy, and while reported for comprehensiveness, were not thought to have been caused by endoscopy. These findings support the relative safety of colonoscopy for colorectal cancer screening, ensuring comprehensive evaluation and optimal preparation for cardiac transplantation. However, these procedures should be performed in centers that routinely manage the specific challenges inherent to these high-risk patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eColorectal Cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart Failure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEjection Fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObstructive Sleep Apnea\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003epHTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulmonary Hypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDAPT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDual Antiplatelet Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnticoagulation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft Ventricular Assist Device\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCerebrovascular Accident\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMyocardial Infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMRd\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMutations and Mismatch Repair-Deficient Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdenoma Detection Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and Consent Statement:\u0026nbsp;\u003c/strong\u003eThis is a retrospective study of already available data, therefore, it does not involve active human participants and/or animals. Hence, formal consent and informed consent were not applicable. IRB approval was obtained before chart review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe dataset analyzed during this study is available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors do not declare any conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNone of the authors has any financial disclosures. No funding was used for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConception of study idea:\u0026nbsp;\u003c/strong\u003eNoor Hassan, MD; Mir Zulqarnain, DO; Wendell Clarkston, MD\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection, drafting of initial manuscript, editing:\u0026nbsp;\u003c/strong\u003eNoor Hassan, MD; Mir Zulqarnain, DO; Ifrah Fatima, MD; Islam Mohamed, MD; Vinay Jahagirdar, MD; Jagadish Koyi, MD; Ameen Awad, MD; Misha Gautam, MD; Abbas Bader; Sruthi Sripada; Thomas Cunningham, MD; Wendell Clarkston, MD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation, analysis:\u0026nbsp;\u003c/strong\u003eNoor Hassan, MD; Mir Zulqarnain, DO; Saqr Alsakarneh, MD; Mohamed Ahmed, MD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReviewing, editing for intellectual content, and final approval of manuscript:\u0026nbsp;\u003c/strong\u003eAll authors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eM. C. (2002). Cardiac transplantation. Heart, \u003cem\u003e87\u003c/em\u003e(2), 177\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/heart.87.2.177\u003c/span\u003e\u003cspan address=\"10.1136/heart.87.2.177\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy SP, Ibrahim NE, Januzzi JL. Heart failure with reduced ejection fraction. JAMA. 2020;324(5):488. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2020.10262\u003c/span\u003e\u003cspan address=\"10.1001/jama.2020.10262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrespo-Leiro MG, Barge-Caballero E. Advanced heart failure. Heart Fail Clin. 2021;17(4):533\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.hfc.2021.06.002\u003c/span\u003e\u003cspan address=\"10.1016/j.hfc.2021.06.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SJ, Kim KH, Hong SK, Hankins S. Evaluation of a heart transplant candidate. Curr Cardiol Rep. 2017;19(12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11886-017-0934-y\u003c/span\u003e\u003cspan address=\"10.1007/s11886-017-0934-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandez-Vivancos C et al. Long-term outcome in heart transplant patients with pretransplant malignancies. Transplant Proc. 2010;42(8):3006\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCostanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transpl. 2010;29(8):914\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.healun.2010.05.034\u003c/span\u003e\u003cspan address=\"10.1016/j.healun.2010.05.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitlock EP, Lin JS, Liles E et al. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. \u003cem\u003eAnn Int Med.\u003c/em\u003e 2008; 149 ([see comment][summary for patients in Ann Intern Med 2008;149:I-44; PMID: 18838719 Epub 2008 Oct 6]): 638\u0026ndash;658.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gie.2011.07.025\u003c/span\u003e\u003cspan address=\"10.1016/j.gie.2011.07.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldberg HJ, Hertz MI, Ricciardi R, Madoff RD, Baxter NN, Bullard KM. Colon and rectal complications after heart and Lung Transplantation. J Am Coll Surg. 2006;202(1):55\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jamcollsurg.2005.08.025\u003c/span\u003e\u003cspan address=\"10.1016/j.jamcollsurg.2005.08.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodriguez-Larrain JM, Ziebert JJ, Kfoury AG, Kuwada S, Taylor DO, Renlund DG. Incidence of adenomatous colorectal polyps in cardiac transplant recipients. Transplantation. 1997;64(3):528\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00007890-199708150-00025\u003c/span\u003e\u003cspan address=\"10.1097/00007890-199708150-00025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaruwala C, Krevsky B. Prevalence of colorectal polyps in potential cardiac transplant recipients. Gastrointest Endosc. 2005;61(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0016-5107(05)01329-5\u003c/span\u003e\u003cspan address=\"10.1016/s0016-5107(05)01329-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS. Perioperative outcome and long-term mortality for heart failure patients undergoing intermediate‐ and high‐risk noncardiac surgery: Impact of left ventricular ejection fraction. Congestive Heart Fail. 2010;16(2):45\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1751-7133.2009.00130.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1751-7133.2009.00130.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLerman BJ, Popat RA, Assimes TL, Heidenreich PA, Wren SM. Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA. 2019;321(6):572. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2019.0156\u003c/span\u003e\u003cspan address=\"10.1001/jama.2019.0156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomaszewski M, Sanders D, Enns R, et al. Risks associated with colonoscopy in a population-based Colon Screening Program: An observational cohort study. CMAJ Open. 2021;9(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.9778/cmajo.20200192\u003c/span\u003e\u003cspan address=\"10.9778/cmajo.20200192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant. 2017;17(11):2761\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ajt.14340\u003c/span\u003e\u003cspan address=\"10.1111/ajt.14340\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristenson ES, Lee V, Wang H, Yarchoan M, De Jesus-Acosta A, Azad N, Gurakar A, Lin MT, Le DT, Brennan DC, Jaffee EM, Bever K. Solid Organ Transplantation Is Associated with an Increased Rate of Mismatch Repair Deficiency and PIK3CA Mutations in Colorectal Cancer. Curr Oncol. 2022;30(1):75\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/curroncol30010006\u003c/span\u003e\u003cspan address=\"10.3390/curroncol30010006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36661655; PMCID: PMC9858144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafaeian M, Robbins HA, Berndt SI, Lynch CF, Fraumeni JF Jr, Engels EA. Risk of Colorectal Cancer After Solid Organ Transplantation in the United States. Am J Transpl. 2016;16(3):960\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ajt.13549\u003c/span\u003e\u003cspan address=\"10.1111/ajt.13549\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2016 Jan 5. PMID: 26731613; PMCID: PMC5218822.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849\u0026ndash;57. W152.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCausada-Calo N, Bishay K, Albashir S, Mazroui A, A., Armstrong D. Association between age and complications after outpatient colonoscopy. JAMA Netw Open. 2020;3(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamanetworkopen.2020.8958\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2020.8958\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTransplants in the U.S. by Recipient Age. Organ Procure Transplantation \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#\u003c/span\u003e\u003cspan address=\"https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026eacute;ndez-Bail\u0026oacute;n M, Jim\u0026eacute;nez-Garc\u0026iacute;a R, Mu\u0026ntilde;oz-Rivas N, Hern\u0026aacute;ndez-Barrera V, de Miguel-Yanes JM, de Miguel-D\u0026iacute;ez J, Andr\u0026egrave;s E, Lorenzo-Villalba N, L\u0026oacute;pez-de-Andr\u0026eacute;s A. Trends and clinical impact of gastrointestinal endoscopic procedures on acute heart failure in Spain (2002\u0026ndash;2017). J Clin Med. 2021;10(3):546. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm10030546\u003c/span\u003e\u003cspan address=\"10.3390/jcm10030546\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu Ghanimeh M, Albadarinb S, Kaddourah O, Alturkmani H, Abughanimeh O, Tahboub M, Derbas L, Clarkston W. Safety of Gastrointestinal Endoscopic Procedures in Patients with Severe Heart Failure. Am J Gastroenterol. 2017;11:S265\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouglas K, Rex. Key quality indicators in colonoscopy, \u003cem\u003eGastroenterology Report\u003c/em\u003e, Volume 11, 2023, goad009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi-org.proxy.library.umkc.edu/10.1093/gastro/goad009\u003c/span\u003e\u003cspan address=\"https://doi-org.proxy.library.umkc.edu/10.1093/gastro/goad009\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"colonoscopy, cardiac transplantation, colorectal cancer","lastPublishedDoi":"10.21203/rs.3.rs-6621989/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6621989/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eComprehensive pre-cardiac transplant evaluation, including routine colorectal cancer (CRC) screening, is vital for optimal organ allocation. Despite the routine use of colonoscopy, data on its risks and outcomes in patients with severe heart failure (HF) undergoing evaluation are limited. We aimed to evaluate risks and clinical outcomes of pre-cardiac transplant screening by comparing colonoscopy safety between patients with severe and nonsevere HF.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e We retrospectively reviewed charts of patients admitted for cardiac transplant evaluation at Saint Luke\u0026rsquo;s Hospital in Kansas City, Missouri, between April 2014 to August 2023. Patients were divided into two cohorts based on ejection fraction (EF): severe HF (EF\u0026thinsp;\u0026lt;\u0026thinsp;30%) and non-severe HF (EF\u0026thinsp;\u0026ge;\u0026thinsp;30%). Demographics and clinical outcomes were compared using descriptive statistics and chi-square tests, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAmong 322 patients, 228 had EF\u0026thinsp;\u0026lt;\u0026thinsp;30% and 94 had EF\u0026thinsp;\u0026ge;\u0026thinsp;30%. Adenoma detection rate was 37.1% in the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group and 26.6% in the EF\u0026thinsp;\u0026lt;\u0026thinsp;30% group. High-grade lesions were detected in 1.8% of the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group and 1.1% of the EF\u0026thinsp;\u0026lt;\u0026thinsp;30% group, with CRC found in 1.1% of the EF\u0026thinsp;\u0026lt;\u0026thinsp;30% group and none in the EF\u0026thinsp;\u0026ge;\u0026thinsp;30% group. Statistical analysis showed no significant differences in adenoma detection (p\u0026thinsp;=\u0026thinsp;0.08), high-grade lesions (p\u0026thinsp;=\u0026thinsp;0.65), or CRC incidence (p\u0026thinsp;=\u0026thinsp;0.92) between the groups. Adverse clinical outcomes such as bleeding, perforation, arrhythmia, hypotension, hypoxia, and respiratory failure were similar in both cohorts (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe risks of screening colonoscopy preceding cardiac transplantation are similar between patients with EF\u0026thinsp;\u0026ge;\u0026thinsp;30% and EF\u0026thinsp;\u0026lt;\u0026thinsp;30%. Safety outcomes and detection rates remain comparable regardless of EF status, supporting colonoscopy as a valuable screening tool in these patients.\u003c/p\u003e","manuscriptTitle":"Safety of Pre-Cardiac Transplant Screening Colonoscopy in Patients with Severe Heart Failure: A Single Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-10 14:46:28","doi":"10.21203/rs.3.rs-6621989/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03a56302-2788-457f-9859-4e9f47b1b18c","owner":[],"postedDate":"June 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-18T22:23:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-10 14:46:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6621989","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6621989","identity":"rs-6621989","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}