Frequency of <i>Helicobacter pylori</i> screening in patients with end-stage liver disease prior to liver transplant

Background: Post-transplant immunosuppression increases malignancy risk. Gastric cancer is one of the most common post-transplant malignancies among high-risk groups including Asian patients. Helicobacter pylori ( H. pylori) is a known risk factor for gastric cancer; however, pre-transplant screening is not standard. This retrospective study assesses the frequency with which patients with end-stage liver disease, prior to liver transplant, are screened for H. pylori using endoscopic or non-endoscopic methods. Methods: We conducted a retrospective chart review of 127 patients who underwent upper endoscopy prior to liver transplant. Data were collected for age, ethnicity, indications for endoscopy, endoscopic findings, endoscopic treatment, gastric biopsy results, and antibiotic/proton pump inhibitor use. Non-endoscopic H. pylori testing within 5 years before transplant was recorded. Results: Among 127 patients, 15 were of Asian and 9 were of Indigenous heritage. The most common indication for endoscopy was variceal surveillance ( n = 83), then gastrointestinal bleeding ( n = 33). Thirty-nine patients had biopsies taken for H. pylori, with four testing positive. Twenty patients had non-endoscopic testing, with three testing positive. Seventy-six patients (60%) underwent no form of testing. In Asian patients, 8 of 15 (53%) had no form of testing. Indigenous and Asian patients demonstrated high positivity rates, with 50% and 14% testing positive, respectively. Conclusions: H. pylori testing was performed in under 40% patients awaiting liver transplant. When tested, positivity was 10% by biopsies and 15% by other methods. Given high prevalence of H. pylori positivity, routine screening via endoscopic or non-endoscopic methods should be employed to mitigate post-transplant gastric malignancy risk.