We thank our colleagues for their interest in our study. Although the risk for colorectal carcinoma after liver transplantation may be increased, our study shows that in this particular, vulnerable population the yield of advanced neoplasia detected by colonoscopy is low and is associated with an elevated risk of complications. In addition, we would like to stress the fact that only just over 50% of the screened patients actually underwent liver transplantation. Based on these data, the timing of performing a screening colonoscopy may be reconsidered, e.g., performing screening colonoscopies post–liver transplantation in a subset of patients.
Although the sensitivity of the fecal immunochemical test (FIT) is low for adenoma and serrated lesions, sensitivity for colorectal carcinoma is around 80%. Therefore, FIT may be used as an alternative to screen patients pre–liver transplantation. We agree that if FIT is chosen, the cutoff used will be essential to assure an optimal benefit–risk balance.
We continue to believe that the benefit–harm ratio of screening colonoscopy in all potential candidate patients for liver transplantation is questionable and that other strategies should be considered and further explored.
Potential conflict of interest: Nothing to report.