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

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.