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Tsarna E, Eleftheriades A, Matsas A, Triantafyllidou O, Christopoulos P. Uterus Transplantation as Infertility Treatment in Gynecological Cancer Survivors: A Systematic Review. J Clin Med 2024; 13:3172. [PMID: 38892883 PMCID: PMC11173303 DOI: 10.3390/jcm13113172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The aim of this systematic review is to summarize the evidence regarding the acceptance of uterine transplantation as infertility treatment among gynecological cancer survivors, surgical and pregnancy outcomes post-transplantation for gynecological cancer survivors, as well as relevant adverse events. Methods: PubMed and Embase were searched for records published since 2000, and extensive reference screening was performed. Results: Out of 1901 unique records identified, 7 are included in this review; 4 examined the proportion of gynecological cancer survivors among applicants for uterine transplantation, 2 examined rejection rates, pregnancy rates, and outcomes after uterine transplantation among gynecological cancer survivors, and 2 reported the frequency of relevant adverse events. Among the applicants, 60/701 (8.6%) were gynecological cancer survivors, only 1 transplanted patient was a cervical cancer survivor and achieved two live births after eight embryo transfers, and 2/27 (7.4%) of uterus transplantation recipients were diagnosed with CIN post-transplantation. Conclusions: Uterus transplantation can be regarded as an infertility treatment for absolute uterine factor infertility (AUFI), although only one gynecological cancer survivor has received a uterus transplantation. The efficacy, safety, and ethical considerations for gynecological cancer survivors need to be addressed for uterine transplantation to become an infertility treatment option for AUFI among gynecological cancer survivors.
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Affiliation(s)
- Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, “Aretaieion” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (A.M.); (O.T.)
| | - Anna Eleftheriades
- Postgraduate Programme “Maternal Fetal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, “Aretaieion” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (A.M.); (O.T.)
| | - Olga Triantafyllidou
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, “Aretaieion” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (A.M.); (O.T.)
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, “Aretaieion” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (A.M.); (O.T.)
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2
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Ring LL, Lindquist S, Rosthøj S, Larsen HK, Hædersdal M, Sørensen SS, Kjaer SK, Sand FL. Prevalence of cervical human papillomavirus in kidney transplant recipients: A systematic review and meta-analysis. Prev Med 2024; 182:107927. [PMID: 38467195 DOI: 10.1016/j.ypmed.2024.107927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to investigate the prevalence of cervical high-risk human papillomavirus (hrHPV) among kidney transplant recipients (KTRs) and, furthermore to compare it to that in immunocompetent controls. METHODS A systematic literature search was conducted in PubMed, EMBASE, and Cochrane Library databases from January 2000 to February 2023, to identify studies investigating the prevalence of cervical hrHPV in KTRs. Pooled cervical hrHPV prevalences, odds ratios (ORs) comparing KTRs to controls and corresponding confidence intervals (CIs) were estimated using random effects logistic regression models. Heterogeneity between studies was assessed through the I2 statistic, and the significance was evaluated by the Cochrane's Q test. RESULTS Altogether, 16 studies covering >1200 KTRs were included. The prevalence of cervical hrHPV in KTRs was 27.7% (95% CI 21.3-35.1) with substantial interstudy heterogeneity. Stratification indicated a higher prevalence in recent years (2019-2023) and in Asia (39% (95% CI 11.2-61.4)). The prevalence of HPV16 and HPV18 in KTRs was 8.0% (95% CI 3.9-15.9) and 1.7% (95% CI 0.8-3.7), respectively. Comparing hrHPV prevalence in KTRs and controls based on six studies including >500 KTRs and 1000 controls, the OR for hrHPV was 2.0 (95% CI 1.1-3.6). CONCLUSIONS This meta-analysis establishes an increased cervical hrHPV prevalence in KTRs compared to controls. The increased risk may be associated with immunosuppressive therapy post-transplantation. Further research is needed to explore the potential benefits of HPV vaccination, including potential revaccination strategies in KTRs.
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Affiliation(s)
- Linea Landgrebe Ring
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Sofie Lindquist
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne Rosthøj
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Helle K Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Merete Hædersdal
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren S Sørensen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark; Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Freja Lærke Sand
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
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Choi S, Ismail A, Pappas-Gogos G, Boussios S. HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens 2023; 12:pathogens12020298. [PMID: 36839570 PMCID: PMC9960303 DOI: 10.3390/pathogens12020298] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.
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Affiliation(s)
- Sunyoung Choi
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - Ayden Ismail
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, 6th Kilometer, 68100 Alexandroupolis, Greece
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or or
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4
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Larsen HK, Kjaer SK, Haedersdal M, Kjaer AK, Bonde JH, Sørensen SS, Thomsen LT. Anal Human Papillomavirus Infection in Kidney Transplant Recipients Compared With Immunocompetent Controls. Clin Infect Dis 2022; 75:1993-1999. [PMID: 35438132 DOI: 10.1093/cid/ciac285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)-related anogenital (pre)cancers, including anal high-grade intraepithelial lesions and cancer. Previous studies on anal high-risk HPV (hrHPV) among KTRs are sparse. METHODS In a cross-sectional study, we included 247 KTRs and 248 controls from a dermatology department and 5 nephrology departments in Denmark during 2016-2017. All participants provided an anal cytobrush sample that was tested for HPV DNA. Participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of anal hrHPV in KTRs compared with controls and risk factors for anal hrHPV in KTRs. RESULTS The anal hrHPV prevalence was higher in female KTRs (45.5%) than in controls (27.2%). Female KTRs had almost 3-fold higher adjusted odds of anal hrHPV than controls (adjusted OR, 2.87 [95% confidence interval, 1.57-5.22]). In contrast, among men we did not observe increased prevalence or odds of anal hrHPV in KTRs compared with controls (prevalence, 19.4% vs 23.6%; adjusted OR, 0.85 [95% 95% confidence interval, .44-1.64]). Among hrHPV-positive KTRs, 63% and 52% of men and women, respectively, were infected with hrHPV types covered by the nonavalent HPV vaccine (type 16, 18, 31, 33, 45, 52, or 58). Current smoking, >10 lifetime sexual partners, history of genital warts, and among men having had receptive anal sex were risk factors for anal hrHPV in KTRs. CONCLUSIONS Female KTRs had an increased risk of anal hrHPV compared with immunocompetent controls. Our findings indicate that pretransplant HPV vaccination should be considered to prevent anal high-grade intraepithelial lesions and cancer caused by anal hrHPV infection in KTRs. CLINICAL TRIALS REGISTRATION NCT03018327.
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Affiliation(s)
- Helle Kiellberg Larsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jesper Hansen Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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5
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Nailescu C, Ermel AC, Shew ML. Human papillomavirus-related cancer risk for solid organ transplant recipients during adult life and early prevention strategies during childhood and adolescence. Pediatr Transplant 2022; 26:e14341. [PMID: 35808949 DOI: 10.1111/petr.14341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/03/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Abstract
Malignancies are among the top three causes of patient death in pediatric and adult kidney transplant (KT) recipients. Solid organ transplant (SOT) recipients, including KT individuals, experience more cancer compared with the general population, including human papillomavirus (HPV)-related anogenital and oropharyngeal cancers. This article describes the epidemiology, pathophysiology and natural history of the HPV infection in both the general population and in SOT recipients, as well as its role in the development of HPV-related pre-cancerous lesions and cancers. Emphasis is given to the primary prevention strategy, HPV vaccination in SOT recipients, and its particularities compared with the general population. Secondary prevention strategies in SOT recipients are discussed and compared with the general population, highlighting cervical cancer screening needs within SOT populations. The article emphasizes how these primary and secondary HPV prevention strategies applied during childhood and adolescence by the pediatric transplant professionals, can lower the burden of HPV-related cancers for SOT recipients in subsequent years, during their adult life.
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Affiliation(s)
- Corina Nailescu
- Section of Pediatric Nephrology and Hypertension, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron C Ermel
- Section of Infectious Diseases, Department of Medicine, Indiana University Health University Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcia L Shew
- Section of Adolescent Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Wielgos A, Pietrzak B, Suchonska B, Sikora M, Rudnicka L, Wielgos M. A Six-Year Gynecological Follow-Up of Immunosuppressed Women with a High-Risk Human Papillomavirus Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3531. [PMID: 35329222 PMCID: PMC8953826 DOI: 10.3390/ijerph19063531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
Immunocompromised women are at an increased risk of developing malignancies, especially those that are viral-induced, such as invasive cervical cancer caused by the human papillomavirus (HPV). The aim of the study was to describe gynecological follow-up of women undergoing chronic immunosuppressive therapy for various reasons (e.g., kidney/liver transplant, systemic lupus erythematosus), diagnosed with a high-risk HPV (hrHPV) infection based on a self-sampling test. Twenty-six hrHPV-positive women were invited to take part in a gynecological follow-up, including a visual assessment of the anogenital region, two-handed gynecological examination, and cervical cytology as well as a colposcopy and cervical biopsy when necessary. Four women declined taking part in the study. Over six years of observation, low-grade squamous intraepithelial lesions (LSIL) were detected at least once in 7/22 women (31.8%), and a cervical intraepithelial lesion 1 (CIN 1) histopathologic result was obtained five times in 3/22 women. No cases of high-grade squamous intraepithelial lesions, CIN 2/3, or invasive cervical cancers were observed. Loop electrosurgical excision procedure (LEEP) was performed in three patients. As immunocompromised women are prone to persistent hrHPV infections, they should be under strict gynecological supervision because only vigilant surveillance enables fast detection and treatment of early dysplasia and, therefore, provides a chance for the reduction of the cervical cancer burden.
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Affiliation(s)
- Aleksandra Wielgos
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Bronisława Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Barbara Suchonska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-006 Warsaw, Poland;
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
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Borin A, Violi P, Eccher A, Zaza G, Carraro A. Carcinogenesis and Cancer Progression in De Novo Anal Squamous Cell Carcinoma After Organ Transplantation: A Systematic Review. EXP CLIN TRANSPLANT 2022; 20:122-129. [PMID: 35282809 DOI: 10.6002/ect.2021.0412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our aim was to perform a comprehensive literature review on the pathogenesis of squamous anal cancerin patients after solid-organ transplant. Medical databases were consulted until June 1, 2020, for potentially relevant publications.All studies on pathogenesis of de novo anal squamous cell carcinoma in solid-organ transplant recipients were included. Two researchers independently performed study selection, quality assessment, and data extraction and analysis. Twenty-one studies were included.None ofthe selected papers had been solely focused on carcinogenesis. Most ofthe studies identified human papillomavirus infection and immunosuppression to be significantly correlated with the development of de novo anal cancer in adult solid organ transplant recipients. CD4+ T-cell depletion and inactivation oftumor suppressor pathways were mainly implicated. All solid-organ transplant recipients, especially those who were human papillomavirus positive, were shown to be at increased risk for the development of posttransplant anal cancer. Further studies are needed to determine the specific mechanisms of pathogenesis according to different solid-organ transplant populations.
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Affiliation(s)
- Alex Borin
- From the Department of General Surgery and Dentistry, Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
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8
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Nailescu C, Shew ML. Human papillomavirus infection-related cancer risk for kidney transplant recipients during adult life can be reduced by vaccination during childhood and adolescence. Front Pediatr 2022; 10:1057454. [PMID: 36533243 PMCID: PMC9749905 DOI: 10.3389/fped.2022.1057454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Malignancies are found between the first three reasons of mortality in pediatric and adult kidney transplant recipients, who overall have disproportionately higher rates of cancer compared to the general population, including human papillomavirus (HPV)-related genital, anal and oropharynx region cancers. Therefore, preventing HPV in this patient population is extremely important. HPV-vaccine was demonstrated to prevent HPV infection in individuals with intact immune systems. In addition, recent data reported less precancerous HPV lesions and cervical cancers with use of HPV vaccine. Since HPV is a sexually transmitted virus that is typically acquired shortly after the onset of sexual activity, it is best to administer the HPV vaccine immunization prior to the onset of sexual activity. This article reviews the epidemiology and pathophysiology of the HPV infection, as well as its role in the development of HPV-related pre-cancerous lesions and cancers in both general population and kidney transplant recipients. The focus is on the most effective primary prophylactic strategy, which is the HPV vaccination. The particularities of HPV vaccination strategies in kidney transplant recipients are compared to the general population. In addition, the article analyzes the various causes of suboptimal HPV immunization rates in kidney transplant candidates and recipients and discusses vaccination optimization strategies that can be applied during childhood and adolescence to reduce the burden of HPV-related disease states and cancer among adult kidney transplant recipients.
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Affiliation(s)
- Corina Nailescu
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Marcia L Shew
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
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9
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Prevalence and Distribution of HPV Genotypes in Immunosuppressed Patients in Lorraine Region. Viruses 2021; 13:v13122454. [PMID: 34960723 PMCID: PMC8707108 DOI: 10.3390/v13122454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/11/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The primary objective of this work was to assess the prevalence and distribution of HPV genotypes in immunosuppressed patients, and to compare them with the French Monsonego cohort. Secondary objectives were to evaluate whether the risk of HPV infection was correlated with HIV viral load, CD4 cell count in HIV-infected patients and the type, number of immunosuppressive therapies or type of pathology (transplant vs. autoimmune diseases) in patients undergoing long-term immunosuppressive therapy. Methods: An observational, monocentric and historical study was conducted including all immunosuppressed patients having received an HPV testing, in the Laboratory of Virology, Nancy Regional Teaching Hospital Center, between 2014 and 2020. Immunosuppressed patients were either HIV-infected or received long-term immunosuppressive therapy. Results: In our cohort, the prevalence of HPV infection (75.6% vs. 16.1% p < 0.05), the proportion of patients with high-risk HPV infection (48.9% vs. 15.1% p < 0.05) and with multiple HPV infection (41.1% vs. 5.7% p < 0.05) were significantly higher than in the Monsonego cohort. HPV 52 (13%), 53 (13%) and 16 (10%) were the most common in the immunosuppressed population, while it was HPV 16, 42 and 51 in the Monsonego cohort. Conclusions: This study supports that a particular attention must be given to all the immunosuppressed patients for the screening and care of HPV-related diseases because of major modifications of HPV epidemiology compared with the overall population.
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10
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Crusz SM, El-Shakankery K, Miller RE. Targeting HPV in gynaecological cancers - Current status, ongoing challenges and future directions. ACTA ACUST UNITED AC 2021; 16:1745506520961709. [PMID: 33296284 PMCID: PMC7731692 DOI: 10.1177/1745506520961709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite the success of preventive vaccination, the Human Papilloma Virus still accounts for 266,000 deaths annually, as the main causative factor of cervical, vaginal, anal, penile and oropharyngeal cancers. Human Papilloma Virus infects epithelial cells, driving tumourigenesis primarily from incorporation of DNA into the host cellular genome. Translation of two particular Human Papilloma Virus-specific oncoproteins, E6 and E7, are the key drivers of malignancy. If diagnosed early cervical, vaginal and vulval cancers have good prognosis and are treated with curative intent. However, metastatic disease carries a poor prognosis, with first-line systemic treatment providing only modest increase in outcome. Having shown promise in other solid malignancies, immune checkpoint inhibition and therapeutic cancer vaccines have been directed towards Human Papilloma Virus-associated gynaecological cancers, mindful that persistent Human Papilloma Virus infection drives malignancy and is associated with immunosuppression and lack of T-cell immunity. In this review, we discuss novel therapeutic approaches for targeting Human Papilloma Virus-driven gynaecological malignancies including vaccination strategies, use of immunomodulation, immune checkpoint inhibitors and agents targeting Human Papilloma Virus-specific oncoproteins. We also highlight the evolving focus on exciting new treatments including adoptive T-cell therapies.
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Affiliation(s)
- Shanthini M Crusz
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | | | - Rowan E Miller
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK.,Department of Medical Oncology, University College London Hospital, London, UK
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11
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Castanon A, Rebolj M, Burger EA, de Kok IMCM, Smith MA, Hanley SJB, Carozzi FM, Peacock S, O'Mahony JF. Cervical screening during the COVID-19 pandemic: optimising recovery strategies. Lancet Public Health 2021; 6:e522-e527. [PMID: 33939965 PMCID: PMC8087290 DOI: 10.1016/s2468-2667(21)00078-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.
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Affiliation(s)
- Alejandra Castanon
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
| | - Matejka Rebolj
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Emily Annika Burger
- Harvard T H Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Megan A Smith
- Daffodil Centre, University of Sydney-Cancer Council, Sydney, NSW, Australia
| | - Sharon J B Hanley
- Department of Obstetrics and Gynaecology, Hokkaido University, Sapporo, Japan
| | | | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada; Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada; Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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12
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Buxeda A, Redondo-Pachón D, Pérez-Sáez MJ, Crespo M, Pascual J. Sex differences in cancer risk and outcomes after kidney transplantation. Transplant Rev (Orlando) 2021; 35:100625. [PMID: 34020178 DOI: 10.1016/j.trre.2021.100625] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
Kidney transplant recipients (KTRs) experience a two- to four-fold increased risk of developing and dying from cancer compared with the general population. High cancer risk results from the interaction of both modifiable and non-modifiable factors. This mapping review explores the impact of sex disparity on cancer's increased incidence and mortality after kidney transplantation (KT). In terms of age, population-based studies indicate that younger recipients of both sexes experience a higher risk of cancer, but this is more pronounced in young women. On the contrary, older men are more likely to be diagnosed with cancer, although their increased risk is not statistically significant compared with the general population. Regarding cancer type, studies show an increased risk of Kaposi sarcoma, gynecologic and lung cancer in women, and bladder and kidney cancer in men. Immune-related cancers such as pos-transplant lymphoproliferative disorders and melanoma are increased in both sexes. Mortality also shows differences between sexes. Although cancer is the second cause of death in both male and female KTRs, studies show higher overall mortality in men and elderly recipients. However, the relative risk of cancer mortality compared with the general population is higher at a younger age, with disparate results regarding sex. Female KTRs appear to die at a younger age than males when compared with the general population. Differences in cancer rates by sex after renal transplantation need further studies. A better understanding of sex-specific differences in cancer epidemiology after KT could help nephrologists to better address pre-transplant counseling, to establish early surveillance programs, and to plan modifiable risk factors such as immunosuppression.
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Affiliation(s)
- Anna Buxeda
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.
| | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
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13
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Imburgia TM, Shew ML, Gravitt PE, Katzenellenbogen RA. Considerations for Child Cancer Survivors and Immunocompromised Children to Prevent Secondary HPV-associated Cancers. Transplantation 2021; 105:736-742. [PMID: 32890137 DOI: 10.1097/tp.0000000000003444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Survivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary human papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives.
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Affiliation(s)
- Teresa M Imburgia
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
- Epidemiology Department, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Marcia L Shew
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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14
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Kardani K, Basimi P, Fekri M, Bolhassani A. Antiviral therapy for the sexually transmitted viruses: recent updates on vaccine development. Expert Rev Clin Pharmacol 2020; 13:1001-1046. [PMID: 32838584 DOI: 10.1080/17512433.2020.1814743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The sexually transmitted infections (STIs) caused by viruses including human T cell leukemia virus type-1 (HTLV-1), human immunodeficiency virus-1 (HIV-1), human simplex virus-2 (HSV-2), hepatitis C virus (HCV), hepatitis B virus (HBV), and human papillomavirus (HPV) are major public health issues. These infections can cause cancer or result in long-term health problems. Due to high prevalence of STIs, a safe and effective vaccine is required to overcome these fatal viruses. AREAS COVERED This review includes a comprehensive overview of the literatures relevant to vaccine development against the sexually transmitted viruses (STVs) using PubMed and Sciencedirect electronic search engines. Herein, we discuss the efforts directed toward development of effective vaccines using different laboratory animal models including mice, guinea pig or non-human primates in preclinical trials, and human in clinical trials with different phases. EXPERT OPINION There is no effective FDA approved vaccine against the sexually transmitted viruses (STVs) except for HBV and HPV as prophylactic vaccines. Many attempts are underway to develop vaccines against these viruses. There are several approaches for improving prophylactic or therapeutic vaccines such as heterologous prime/boost immunization, delivery system, administration route, adjuvants, etc. In this line, further studies can be helpful for understanding the immunobiology of STVs in human. Moreover, development of more relevant animal models is a worthy goal to induce effective immune responses in humans.
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Affiliation(s)
- Kimia Kardani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Parya Basimi
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Mehrshad Fekri
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Azam Bolhassani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
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15
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Klitzke S, Wender IO, Salcedo MP, Pessini SA. Cervical cancer screening abnormalities in immunosuppressed renal transplant women: case-control study in Southern Brazil. Arch Gynecol Obstet 2020; 302:649-655. [PMID: 32488400 DOI: 10.1007/s00404-020-05621-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the prevalence of cervical pre-malignancies in the cervical cytology of female renal transplant recipients (RTR) and compare to immunocompetent patients. METHODS A prospective case-control study of 165 RTR (cases) and 372 immunocompetent women (controls) was carried out from May 2015 to August 2016. The participants completed a questionnaire with demographic characteristics, habits, reproductive history, and information about the renal transplant. Cervical cytology samples were collected at their visit for cervical cancer screening. Relevant medical history was obtained from medical records and previous cervical cytology results were retrieved: from the time of kidney transplantation to the beginning of this study for RTR and all collected throughout life for controls. RESULTS The mean age was similar between groups (42.6 ± 11.4 vs. 41.8.2 ± 11.1 years, p = 0.447). Considering cervical cytology collected since the kidney transplant, RTR had three times higher rates of abnormal cervical cytology test (24.8% of RTR vs. 6.3% for controls), and the abnormalities were more frequent (p < 0.001) for low squamous intraepithelial lesion (LSIL) (n = 23, 13.9%) and high squamous intraepithelial lesion (HSIL) (n = 9, 5.5%). Cervical cytology collected during the study had normal results in 152 RTR (92.1%) vs. 326 controls (93.9%) (p > 0.05). When the altered results were broken down, a higher frequency of LSIL could be seen in RTR (3.6% vs 0.0%, p = 0.008). CONCLUSION RTR had significantly higher rates of cervical cytology abnormalities comparing to the control group and most of it was composed of LSIL.
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Affiliation(s)
- Sibele Klitzke
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isabella Osorio Wender
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Mila Pontremoli Salcedo
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal de Ciências da Saúde de Porto Alegre/Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Suzana Arenhart Pessini
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Department of Obstetrics and Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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16
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Suwalska A, Smolarczyk K, Kosieradzki M, Fiedor P. Correlation of Cancer Development and Human Papilloma Virus Infection in Patients After Organ Transplantation. Transplant Proc 2020; 52:1982-1984. [PMID: 32474002 DOI: 10.1016/j.transproceed.2020.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 01/20/2023]
Abstract
Immunosuppressed patients are at higher risk of developing human papilloma virus (HPV) cancerous and precancerous lesions in the anogenital region Carcinogenesis after organ transplantation due to immunosuppressive therapy is the major cause of long-term negative transplantation results. This is a rationale for the improvement of transplantation programs with carcinogenesis risk stratification in patients referred for transplantation. There is a need for a study on HPV-related carcinogenesis also in terms of its risk factors in the population after organ transplantation. This study aimed to assess the morbidity of anogenital carcinoma in patients with HPV infection, including those after organ transplantation and evaluate risk factors for carcinoma occurrence in patients after organ transplantation and with HPV infection. Our analysis directly indicates the group of patients with a high risk of HPV-related oncological complications of immunosuppression in anogenital region.
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Affiliation(s)
- Anna Suwalska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Smolarczyk
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland.
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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17
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Nailescu C, Nelson RD, Verghese PS, Twombley KE, Chishti AS, Mills M, Mahan JD, Slaven JE, Shew ML. Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study. Front Pediatr 2020; 8:46. [PMID: 32154194 PMCID: PMC7045870 DOI: 10.3389/fped.2020.00046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/28/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Kidney transplant (KT) recipients have higher incidence of malignancies, including Human Papillomavirus (HPV)-associated cancers. Thus, HPV vaccines may have an important role in preventing HPV-related disease in this population; however, immunogenicity and safety data are lacking. Objective: To examine the immunological response and tolerability to HPV vaccination in pediatric KT recipients compared to future KT candidates. Methods: The quadrivalent HPV vaccine was administered to girls and boys age 9-18 recruited from seven centers part of the Pediatric Nephrology Research Consortium. Subjects were recruited for three groups: (1) CKD: chronic kidney disease stages 3, 4, and 5 not on dialysis; (2) Dialysis; (3) KT recipients. The outcome consisted of antibody concentrations against HPV 6, 11, 16, and 18. Geometric mean titers (GMTs) and seroconversion rates were compared. Vaccine tolerability was assessed. Results: Sixty-five participants were recruited: 18 in the CKD, 18 in the dialysis, and 29 into the KT groups. KT patients had significantly lower GMTs after vaccination for all serotypes. The percentages of subjects who reached seroconversion were overall lower for the KT group, reaching statistical significance for HPV 6, 11, and 18. Comparing immunosuppressed subjects (anyone taking immunosuppression medications, whether KT recipient or not) with the non-immunosuppressed participants, the former had significantly lower GMTs for all the HPV serotypes and lower seroconversion rates for HPV 6, 11, and 18. KT females had higher GMTs and seroconversion rates for certain serotypes. There were no adverse events in either group. Conclusions: HPV vaccine was well-tolerated in this population. Pediatric KT recipients had in general lower GMTs and seroconversion rates compared to their peers with CKD or on dialysis. Immunosuppression played a role in the lack of seroconversion. Our results emphasize the importance of advocating for HPV vaccination prior to KT and acknowledge its safety post transplantation. Future studies are needed to investigate the effect of a supplemental dose of HPV vaccine in KT recipients who do not seroconvert and to evaluate the long-term persistence of antibodies post-KT.
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Affiliation(s)
- Corina Nailescu
- Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, United States
| | - Raoul D Nelson
- Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, UT, United States
| | - Priya S Verghese
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
| | - Katherine E Twombley
- Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC, United States
| | - Aftab S Chishti
- Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Michele Mills
- Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - James E Slaven
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Marcia L Shew
- Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, United States
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18
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Buxeda A, Redondo-Pachón D, Pérez-Sáez MJ, Bartolomé Á, Mir M, Pascual-Dapena A, Sans A, Duran X, Crespo M, Pascual J. Gender differences in cancer risk after kidney transplantation. Oncotarget 2019; 10:3114-3128. [PMID: 31139324 PMCID: PMC6517099 DOI: 10.18632/oncotarget.26859] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023] Open
Abstract
Kidney transplant (KT) recipients are at greater risk of developing some cancers than the general population. Moreover, cancer is the only cause of death that is currently increasing after kidney transplantation. We analyzed incidence, risk factors and characteristics of post-transplant malignancies (solid organ tumors and lymphoproliferative disorders) at our center in 925 KT recipients (1979-2014). Sex differences were particularly assessed. One hundred and eight patients (11.7%) developed solid organ tumors (76.9%) or lymphoma (23.1%). Twenty-one percent of patients who reached 20 years after KT developed cancer, with a median post-KT time to diagnosis of 7.4 years. Most common solid organs affected were lung (30.1%), prostate (10.8%), bladder (9.6%), and native kidney (7.2%). When analyzing standardized incidence ratios (SIR) by gender compared to the general population, relative risk was increased in women (SIR = 1.81; 95%CI, 1.28-2.45) but not significantly increased in men (SIR = 1.22; 0.95-2.52). Regarding specific types, gynecological (SIR = 11.6; 4.2-22.7) and lung (SIR = 10.0; 4.3-18.2) in women, and bladder (SIR = 16.3; 5.9-32.1) in men were the most affected locations. Thymoglobulin, a polyclonal antibody that has been used as an immunosuppressive agent in kidney transplantation over the last decades, was a significant risk factor for developing cancer in adjusted regression analysis [IRR = 1.62, 1.02-2.57; p = 0.041], and was associated with lower patient survival. Compared with the general population, the incidence of post-KT non-skin cancer is almost two-fold higher in women but not significantly higher in men. Lung is the most common solid organ affected. Thymoglobulin induction therapy is associated with a greater risk.
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Affiliation(s)
- Anna Buxeda
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - Álvaro Bartolomé
- Department of Medicine, University Autonoma Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu-Fabra, Barcelona, Spain
| | - Marisa Mir
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Ana Pascual-Dapena
- Department of Medicine, University Autonoma Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu-Fabra, Barcelona, Spain
| | - Anna Sans
- Department of Medicine, University Autonoma Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, University Pompeu-Fabra, Barcelona, Spain
| | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Department of Medicine, University Autonoma Barcelona, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Department of Medicine, University Autonoma Barcelona, Barcelona, Spain
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19
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Vaccinations in pediatric kidney transplant recipients. Pediatr Nephrol 2019; 34:579-591. [PMID: 29671067 DOI: 10.1007/s00467-018-3953-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians. This article will focus on those deviations from the normal vaccine schedule important in the care of pediatric KT recipients. The article will also review human papillomavirus vaccine due to its special importance in cancer prevention. Live vaccines are generally contraindicated in KT recipients. However, we present a brief review of live vaccines in organ transplant recipients, as there is evidence that certain live virus vaccines may be safe and effective in select groups. Lastly, we review vaccination of pediatric KT recipients prior to international travel.
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20
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Eleutério J, Cavalcante LR, Gonçalves AKS, Eleutério RMN, Giraldo PC. Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women. Diagn Cytopathol 2019; 47:783-787. [PMID: 30897299 DOI: 10.1002/dc.24180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/23/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022]
Affiliation(s)
- José Eleutério
- Department of Maternal and Child Health, Faculty of MedicineFederal University of Ceará Fortaleza Brazil
- Division of Molecular BiologyProf. Eleuterio Laboratory Fortaleza Brazil
| | - Liana R. Cavalcante
- Department of Maternal and Child Health, Faculty of MedicineFederal University of Ceará Fortaleza Brazil
| | - Ana K. S. Gonçalves
- Gynecology and Obstetrics DepartmentFederal University of Rio Grande do Norte Natal Brazil
| | | | - Paulo C. Giraldo
- Gynecology and Obstetrics DepartmentState University of Campinas Campinas Brazil
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21
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22
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Larsen HK, Thomsen LT, Haedersdal M, Dehlendorff C, Schwartz Sørensen S, Kjaer SK. Risk of genital warts in renal transplant recipients-A registry-based, prospective cohort study. Am J Transplant 2019; 19:156-165. [PMID: 30080315 DOI: 10.1111/ajt.15056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 01/25/2023]
Abstract
Genital warts (GWs) are a risk factor for subsequent human papillomavirus (HPV)-related anogenital cancers. In this register-based, prospective cohort study, we estimated the risk of GWs in renal transplant recipients (RTRs) compared with a nontransplanted cohort. In a nationwide database, we identified first-time RTRs in Denmark during 1996 to 2015. For each RTR, 50 age- and sex-matched nontransplanted individuals were selected from the population registry. Information on GWs, sociodemographic characteristics, HPV vaccination, and other causes of immunosuppression was retrieved from registries. We estimated the cumulative incidence of GWs and used Cox regression to estimate hazard ratios (HR) of GWs in RTRs vs non-RTRs. We included 3268 RTRs and 162 910 non-RTRs without GWs 1 year before baseline. RTRs had higher hazard of GWs than non-RTRs (HR = 3.30; 95% confidence interval, 2.76-3.93, adjusted for sex, age, education, and income). The increased hazard of GWs compared with non-RTRs was more pronounced in female than in male RTRs. Although not statistically significant, the hazard tended to be higher in RTRs with functioning grafts compared with RTRs on dialysis after graft failure. The hazard of GWs was increased <1 year after transplantation and remained increased during ≥10 years. In conclusion, RTRs had substantially higher risk of GWs than non-RTRs.
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Affiliation(s)
- Helle Kiellberg Larsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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23
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Gunawansa N, Rathore R, Sharma A, Halawa A. Vaccination practices in End Stage Renal Failure and Renal Transplantation; Review of current guidelines and recommendations. World J Transplant 2018; 8:68-74. [PMID: 29988933 PMCID: PMC6033742 DOI: 10.5500/wjt.v8.i3.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/02/2018] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
Due to the increased burden of infectious complications following solid organ transplantation, vaccination against common pathogens is a hugely important area of discussion and application in clinical practice. Reduction in infectious complications will help to reduce morbidity and mortality post-transplantation. Immunisation history is invaluable in the work-up of potential recipients. Knowledge of the available vaccines and their use in transplant recipients, donors and healthcare providers is vital in the delivery of quality care to transplant recipients. This article will serve as an aide-memoire to transplant physicians and health care professionals involved in managing transplant recipients as it provides an overview of different types of vaccines, timing of vaccination, vaccines contraindicated post solid organ transplantation and travel vaccines.
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Affiliation(s)
- Nalaka Gunawansa
- National Institute of Nephrology Dialysis and Transplantation, Sri Lanka and Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool 111, United Kingdom
| | - Roshni Rathore
- Department of Renal, University Hospitals of Coventry and Warwickshire and Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool 111, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool and Royal Liverpool University Hospital, Liverpool 111, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool and Royal Liverpool University Hospital, Liverpool 111, United Kingdom
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24
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Simundic T, Zibar L, Sego K. Everolimus and papillomavirus lesions in female renal transplant recipient: A case report. Gynecol Oncol Rep 2018; 25:63-64. [PMID: 29928683 PMCID: PMC6008281 DOI: 10.1016/j.gore.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 01/05/2023] Open
Abstract
We describe the case of a transplanted patient with high-risk HPV infection that manifested as multiple genital condylomas and abnormal Papanicolaou (Pap) smear. Her immunosuppressants were corticosteroids, cyclosporine, and azathioprine. Since gynecologic treatments to eradicate condylomas were completely unsuccessful, cyclosporine was replaced by everolimus. Soon after, condylomas disappeared, HPV status became negative, and Pap smear returned to normal and has remained normal since. Kidney transplant recipients with hrHPV infection require close monitoring. Close monitoring also includes changes in IS therapy with emphasis on mTORi. mTOR signaling pathway is activated in HPV-positive and negative cervical carcinoma. Switching to mTORi has helped our patient to fully normalize gynecological findings.
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Affiliation(s)
- T Simundic
- Department of Nephrology, University Hospital Center Osijek, Huttlerova 4, 31000 Osijek, Croatia.,Faculty of Medicine, University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
| | - L Zibar
- Department of Nephrology, University Hospital Center Osijek, Faculty of Medicine, University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
| | - K Sego
- Department of Cardiovascular Surgery, University Hospital Center Osijek, Faculty of Medicine, University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
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25
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Suivi et prise en charge gynécologique chez les femmes atteintes de mucoviscidose. Rev Mal Respir 2018; 35:592-603. [DOI: 10.1016/j.rmr.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
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26
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High proportion of abnormal pap smear tests and cervical dysplasia in women with cystic fibrosis. Eur J Obstet Gynecol Reprod Biol 2018; 221:40-45. [DOI: 10.1016/j.ejogrb.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
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27
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Hancock G, Hellner K, Dorrell L. Therapeutic HPV vaccines. Best Pract Res Clin Obstet Gynaecol 2018; 47:59-72. [PMID: 29108943 DOI: 10.1016/j.bpobgyn.2017.09.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 12/22/2022]
Abstract
High-risk human papillomavirus (HPV) infection is known to be a necessary factor for cervical and anogenital malignancies. Cervical cancers account for over a quarter of a million deaths annually. Despite the availability of prophylactic vaccines, HPV infections remain extremely common worldwide. Furthermore, these vaccines are ineffective at clearing pre-existing infections and associated preinvasive lesions. As cervical dysplasia can regress spontaneously, a therapeutic HPV vaccine that boosts host immunity could have a significant impact on the morbidity and mortality associated with HPV. Therapeutic vaccines differ from prophylactic vaccines in that they are aimed at generating cell-mediated immunity rather than neutralising antibodies. This review will cover various therapeutic vaccine strategies in development for the treatment of HPV-associated lesions and cancers.
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Affiliation(s)
- Gemma Hancock
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Headington, Oxford, UK.
| | - Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Headington, Oxford, UK; Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
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28
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Roensbo MT, Blaakaer J, Skov K, Hammer A. Cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. Acta Obstet Gynecol Scand 2017; 97:142-150. [PMID: 29156081 DOI: 10.1111/aogs.13261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Women receiving immunosuppressive treatment due to organ transplantation are at increased risk of Human papilloma virus (HPV)-related diseases, including cervical neoplasia. This pilot study aimed to describe the cervical HPV prevalence and genotype distribution in immunosuppressed Danish women. MATERIAL AND METHODS We included women who underwent renal (RTR) or bone marrow transplantation (BMTR) in 2009-2012 or 2014 at Aarhus University Hospital, Denmark. Women undergoing transplantation in 2009-2012 had one cervical cytology performed, whereas women undergoing transplantation in 2014 had three, one before and two after transplantation. The samples were examined for cytological abnormalities and tested for HPV using Cobas® HPV Test and CLART® HPV2 Test. RESULTS Of 94 eligible cases we included 60 RTR and BMTR. The overall prevalence of high-risk HPV was 15.0 [95% confidence interval (CI) 7.1-26.6] and the prevalence was higher among BMTR (29.4; 95% CI 10.3-56.0) than RTR (9.3%, 95% CI 2.6-22.1), although this was not statistically significant (p = 0.10). The distribution of high-risk HPV was broad, with HPV 45 as the most common genotype (3.3%). The prevalences of high-risk HPV types included in the bivalent/quadrivalent and the nonavalent vaccines were 1.7 and 8.3%, respectively. The prevalence of low-grade and high-grade cytological abnormalities was 6.7 and 5.0%, respectively. CONCLUSIONS Immunosuppressed women were infected with a broad range of high-risk HPV genotypes and the prevalence of cytological abnormalities was higher than found in previous studies of the general population. The nonavalent HPV vaccine will offer immunosuppressed individuals a greater protection against HPV-related diseases compared with the bivalent/quadrivalent HPV vaccines.
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Affiliation(s)
- Mette T Roensbo
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Emergency, Viborg Hospital, Viborg, Denmark
| | - Jan Blaakaer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Herning Hospital, Herning, Denmark
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Satmary W, Holschneider CH, Brunette LL, Natarajan S. Vulvar intraepithelial neoplasia: Risk factors for recurrence. Gynecol Oncol 2017; 148:126-131. [PMID: 29126556 DOI: 10.1016/j.ygyno.2017.10.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We studied a large population of women with high-grade vulvar intraepithelial neoplasia (VIN) in order to identify patient and treatment-related risk factors for recurrence and progression to cancer. METHODS For this retrospective cohort study of women with a histologic diagnosis of VIN within Southern California Permanente Medical Group between 1995 and 2007 medical records were reviewed; clinical, demographic and pathologic data were collected. Statistical analyses included Chi-squared and Student's t-tests, univariate and multivariate logistic regression, and cumulative incidence analysis. RESULTS 914 patients with high-grade VIN were identified; 784 met inclusion criteria. We found 26.3% recurrences among treated women, with 2.2% progression to cancer (8.2% among those with recurrence). Risk factors for recurrence on multivariate analysis were: age >50years (OR, 1.44; 95%CI 1.01-2.07), immunosuppression (OR 2.08; 95%CI 1.42-3.06), metasynchronous VAIN or CIN (OR 1.76; 95%CI 1.08-2.88) in addition to margin status (OR 8.17; 95%CI 4.60-14.51) and adjacent LSA (OR 9.91; 95%CI 1.53-31.32) or HPV (OR 2.15; 95%CI 1.13-3.37) with excisional treatment. Recurrence rates did not differ significantly by smoking status and treatment modalities. Median time to recurrence was 16.9months; 25% had late recurrences (44-196months). Cumulative incidence analyses of time to recurrence shows a significantly higher risk among patients over age 50 (log-rank p=0.0031). CONCLUSION We identified independent risk factors for recurrence including age >50years, immunosuppression, metasynchronous vaginal or intraepithelial neoplasia, positive excision margins, and adjacent lichen sclerosus or human papilloma-virus. Regardless of treatment modality, 25% of recurrences occurred late, highlighting the need for long-term surveillance in women treated for VIN.
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Affiliation(s)
- W Satmary
- Department of Obstetrics & Gynecology, Kaiser Permanente Medical Center, Panorama City, CA 91402, United States.
| | - C H Holschneider
- Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States; David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, United States
| | - L L Brunette
- LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 90033, United States
| | - S Natarajan
- Department of Pathology, Kaiser Permanente Medical Center, Los Angeles, CA 90027, United States
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Risk Factors for De Novo Malignancies in Women After Kidney Transplantation: A Multicenter Transversal Study. Int J Gynecol Cancer 2017; 26:967-70. [PMID: 27206219 DOI: 10.1097/igc.0000000000000710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Transplantation results in a 5-time elevated risk for a variety of malignancies (Kaposi sarcoma, skin, liver, lung, gastrointestinal cancer). A patient's risk for malignancies could be of particular interest for the follow-up programs of patients and risk adaption after kidney transplantation. The aim of this study was to identify independent risk factors for de novo malignancies in women after renal transplantation. METHODS AND MATERIALS This is a multicenter transversal study, conducted at the Medical University of Vienna and Hospital Rudolfstiftung, Vienna, Austria. We included female kidney graft recipients who were transplanted between 1980 and 2012 and followed-up at our institutions (N = 280). Clinical data of patients were extracted from hospital charts and electronic patient files. Patients were interviewed using a standardized questionnaire regarding their medical history, history of transplantation, and malignant diseases. Detailed information about present and past immunosuppressive regimens, rejection episodes and therapies, renal graft function, and information about primary disease was obtained. Diagnostic work-up and/or surgical exploration was performed if any presence of malignancy was suspected during routine follow-up. Histological specimens were obtained from all patients. MAIN OUTCOME MEASURES the presence of de novo malignancy after kidney transplantation. RESULTS Two hundred sixty-two women were included for statistical analysis. Median (interquartile range) follow-up period after transplantation was 101.1 (27.3-190.7) months. Thirty-two patients (12.2%) developed a malignancy: dermatologic malignancies (5.7%), breast cancer (3.4%), cervical cancer (0.8%), lung cancer (0.4%), gastrointestinal malignancies (1.5%), vulvar cancer (0.4%), and unclassified malignancies (1.9%). Median (interquartile range) time to malignancy after transplantation was 185.9 (92.0-257.6) months. Cumulative cancer rates were 4.9% (1 year), 14.4% (3 years), 16.4% (5 years), and 21.8% (10 years). Second transplantations were identified as independent risk factor for development of malignancy after transplantation. CONCLUSIONS Long-term risk of developing a malignancy after kidney transplantation is high, which might justify a follow-up of more than 10 years.
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Rademacher S, Seehofer D, Eurich D, Schoening W, Neuhaus R, Oellinger R, Denecke T, Pascher A, Schott E, Sinn M, Neuhaus P, Pratschke J. The 28-year incidence of de novo malignancies after liver transplantation: A single-center analysis of risk factors and mortality in 1616 patients. Liver Transpl 2017; 23:1404-1414. [PMID: 28590598 DOI: 10.1002/lt.24795] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/08/2017] [Accepted: 05/14/2017] [Indexed: 12/13/2022]
Abstract
De novo malignancies (DNMs) are one of the leading causes of late mortality after liver transplantation (LT). We analyzed 1616 consecutive patients who underwent LT between 1988 and 2006 at our institution. All patients were prospectively observed over a study period of 28 years by our own outpatient clinic. Complete follow-up data were available for 96% of patients, 3% were incomplete, and only 1% were lost to follow-up. The median follow-up of the patients was 14.1 years. Variables with possible prognostic impact on the development of DNMs were analyzed, as was the incidence of malignancies compared with the nontransplant population by using standardized incidence ratios. In total, 266 (16.5%) patients developed 322 DNMs of the following subgroups: hematological malignancies (n = 49), skin cancer (n = 83), and nonskin solid organ tumors (SOT; n = 190). The probability of developing any DNM within 10 and 25 years was 12.9% and 23.0%, respectively. The respective probability of developing SOT was 7.8% and 16.2%. Mean age at time of diagnosis of SOT was 57.4 years (range, 18.3-81.1 years). In the multivariate analysis, an increased recipient age (hazard ratio [HR], 1.03; P < 0.001) and a history of smoking (HR, 1.92; P < 0.001) were significantly associated with development of SOT. Moreover, the development of SOT was significantly increased in cyclosporine A-treated compared with tacrolimus-treated patients (HR, 1.53; P = 0.03). The present analysis shows a disproportionate increase of de novo SOT with an increasing follow-up period. Increased age and a history of smoking are confirmed as major risk factors. Moreover, the importance of immunosuppression is highlighted. Liver Transplantation 23 1404-1414 2017 AASLD.
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Affiliation(s)
- Sebastian Rademacher
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum.,Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Dennis Eurich
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
| | - Wenzel Schoening
- Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Aachen, Germany
| | - Ruth Neuhaus
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
| | - Robert Oellinger
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
| | | | - Andreas Pascher
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
| | | | - Mariann Sinn
- Hematology and Oncology, Charité Campus Virchow, Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Neuhaus
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
| | - Johann Pratschke
- Departments of Surgery, Campus Charité Mitte and Campus Virchow Klinikum
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Garritsen FM, Verheijen RHM, Gerestein CG, van Zuilen AD, Oosterhaven JAF, van Dijk M, Bruijnzeel-Koomen CAF, Schuttelaar ML, de Bruin-Weller MS. Is there an increased risk of cervical neoplasia in atopic dermatitis patients treated with oral immunosuppressive drugs? J Eur Acad Dermatol Venereol 2017; 32:271-275. [PMID: 28925576 DOI: 10.1111/jdv.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral immunosuppressive drugs are frequently prescribed in young women with atopic dermatitis (AD). Immunocompromised patients may have a higher risk of developing high-risk HPV infections, cervical intra-epithelial neoplasia (CIN) and cervical carcinoma. Most literature on patients using oral immunosuppressive drugs is available in organ transplant patients. Literature on the risk of developing cervical carcinoma in AD patients treated with oral immunosuppressive drugs is lacking. At this moment, there is no clear guideline/consensus on this topic, but in daily practice, questions arise concerning whether this risk is increased and whether more intensive screening in women using immunosuppressive drugs should take place. OBJECTIVE To investigate the occurrence of cervical carcinoma in women with AD treated with oral immunosuppressive drugs. METHODS In this retrospective cohort study in two university medical centres in the Netherlands, all female adult AD patients receiving oral immunosuppressive drugs (cyclosporine A, azathioprine, methotrexate, mycophenolate mofetil, enteric-coated mycophenolate sodium and extended release tacrolimus) for more than 2 months between 1989 and 1 January 2014 were included. Patient files in the national histopathology register were screened for PAP3a, CIN I, CIN II, CIN III and cervical carcinoma. RESULTS A total of 257 female AD patients with one or more treatment episodes from 1989 until 1 January 2014 were identified and included in this study. In 189 patients (73.5%), results of cervical examination were reported in the national histopathology database. Median total duration of treatment in these 189 women was 407.0 days (IQR 243.0-940.0). No cervical carcinoma during or following immunosuppressive therapy was found in our patient group. CONCLUSIONS No intensified screening programme for cervical neoplasia seems necessary for women with AD using oral immunosuppressive drugs.
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Affiliation(s)
- F M Garritsen
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
| | - R H M Verheijen
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - C G Gerestein
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - A D van Zuilen
- Department of Nefrology, University Medical Center, Utrecht, The Netherlands
| | - J A F Oosterhaven
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M van Dijk
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | | | - M L Schuttelaar
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
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Fishman JA. Infection in Organ Transplantation. Am J Transplant 2017; 17:856-879. [PMID: 28117944 DOI: 10.1111/ajt.14208] [Citation(s) in RCA: 454] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 01/25/2023]
Abstract
The prevention, diagnosis, and management of infectious disease in transplantation are major contributors to improved outcomes in organ transplantation. The risk of serious infections in organ recipients is determined by interactions between the patient's epidemiological exposures and net state of immune suppression. In organ recipients, there is a significant incidence of drug toxicity and a propensity for drug interactions with immunosuppressive agents used to maintain graft function. Thus, every effort must be made to establish specific microbiologic diagnoses to optimize therapy. A timeline can be created to develop a differential diagnosis of infection in transplantation based on common patterns of infectious exposures, immunosuppressive management, and antimicrobial prophylaxis. Application of quantitative molecular microbial assays and advanced antimicrobial therapies have advanced care. Pathogen-specific immunity, genetic polymorphisms in immune responses, and dynamic interactions between the microbiome and the risk of infection are beginning to be explored. The role of infection in the stimulation of alloimmune responses awaits further definition. Major hurdles include the shifting worldwide epidemiology of infections, increasing antimicrobial resistance, suboptimal assays for the microbiologic screening of organ donors, and virus-associated malignancies. Transplant infectious disease remains a key to the clinical and scientific investigation of organ transplantation.
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Affiliation(s)
- J A Fishman
- Transplant Infectious Disease and Immunocompromised Host Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Cistjakovs M, Sultanova A, Jermakova O, Chapenko S, Lesina-Korne B, Rozental R, Razeberga D, Murovska M, Ziedina I. Human papillomavirus type 18 infection in a female renal allograft recipient: a case report. J Med Case Rep 2016; 10:318. [PMID: 27829434 PMCID: PMC5101687 DOI: 10.1186/s13256-016-1090-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus type 18 is the second most common cause of cervical cancer and is found in 7 to 20 % of cases of cervical cancer. The oncogenic potential of high-risk human papillomavirus is associated with expression of early proteins E6 and E7. Due to long-term immunosuppressive therapy, renal transplant recipients have a higher risk of developing persistent human papillomavirus infection. CASE PRESENTATION A 29-year-old white woman from Latvia with chronic focal segmental glomerulosclerosis received renal allograft transplantation and was prescribed immunosuppressive therapy with cyclosporine, prednisolone, and mycophenolate mofetil. Two weeks after renal transplantation, her cervical swab was positive for human papillomavirus consensus sequences. After 6 months, quantitative polymerase chain reaction showed a high viral load of 3,630,789 copies/105 cells of high-risk human papillomavirus type 18 and expression of E6 and E7 oncogenes in her cervical swab and urine sample. One year after renal transplantation, the viral load in her cervical swab increased significantly to 7,413,102 copies/105 cells. Messenger ribonucleic acid of human papillomavirus type 18 E6 and E7 oncogenes were also detected. Shortly after this, she had an unsuccessful pregnancy which resulted in a spontaneous abortion at 6/7 weeks. Two months after the abortion her viral load sharply decreased to 39 copies/105 cells. Oncogenes E6 and E7 messenger ribonucleic acid expression was not observed in this period. CONCLUSIONS This case report represents data which show that immunosuppressive therapy may increase the risk of developing persistent high-risk human papillomavirus infection with expression of E6 and E7 oncogenes in renal transplant recipients. However, even during this therapy the immune status of a recipient can improve and contribute to human papillomavirus viral load reduction. Spontaneous abortion can be considered a possible contributory factor in human papillomavirus clearance.
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Affiliation(s)
- Maksims Cistjakovs
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia.
| | - Alina Sultanova
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Olga Jermakova
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Svetlana Chapenko
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Baiba Lesina-Korne
- Gynecology and Maternity Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Rafail Rozental
- Transplant Research Laboratory, Riga Stradins University, Riga, Latvia
| | - Dace Razeberga
- Gynecology and Maternity Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Modra Murovska
- August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Ieva Ziedina
- Transplant Research Laboratory, Riga Stradins University, Riga, Latvia
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Katabathina VS, Menias CO, Tammisetti VS, Lubner MG, Kielar A, Shaaban A, Mansour J, Surabhi VR, Hara AK. Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review. Radiographics 2016; 36:1390-407. [DOI: 10.1148/rg.2016150175] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Uterus transplantation in France: for which patients? Eur J Obstet Gynecol Reprod Biol 2016; 205:7-10. [PMID: 27552172 DOI: 10.1016/j.ejogrb.2016.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Uterine infertility (UI), which can be caused by a variety of congenital or acquired factors, affects several thousand women in Europe. Uterus transplantation (UTx), at the current stage of research, offers hope for these women to be both the biological mother and the carrier of their child. However, the indications of UTx still need to be defined. The main aim of the study was to describe the different etiologies of UI and other data as marital and parental status from women requesting UTx who contacted us in the framework of a UTx clinical trial. Secondarily, we discussed the potential indications of UTx and their feasibility. STUDY DESIGN This is an observational study. RESULTS Of a total of 139 patients with UI, 105 patients (75.5%) had uterine agenesis, making it the leading cause of UI in this sample. Among the patients with uterine agenesis, 25% had a solitary kidney and 44.7% had undergone vaginal reconstruction. Peripartum hysterectomy, hysterectomy for cancer, and hysterectomy for benign pathologies accounted for 9.4%, 7.2% and 5% of cases, respectively. Less common causes of UI included complete androgen insensitivity syndrome (2.2% of patients) and prenatal diethylstilbestrol exposure (0.7%). Approximately 14% of the women already had at least one child and 66% were in a couple living together for at least 2 years. CONCLUSION UTx is still under evaluation and further research is under way. Nulliparous patients with no major medical or surgical history and with normal ovarian function, who meet the legal criteria for medically assisted reproduction, represent the best indications for UTx at this stage of its development.
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Doycheva I, Amer S, Watt KD. De Novo Malignancies After Transplantation: Risk and Surveillance Strategies. Med Clin North Am 2016; 100:551-67. [PMID: 27095645 DOI: 10.1016/j.mcna.2016.01.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
De novo malignancies are one of the leading causes of late mortality after liver and kidney transplantation. Nonmelanoma skin cancer is the most common malignancy, followed by posttransplant lymphoproliferative disorder and solid organ tumors. Immunosuppression is a key factor for cancer development, although many other transplant-related and traditional risk factors also play a role. In this review, the authors summarize risk factors and outcomes of frequently encountered de novo malignancies after liver and kidney transplantation to stratify recipients at highest risk. Future efforts in prospectively validated, cost-effective surveillance strategies that improve survival of these complex patients are greatly needed.
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Affiliation(s)
- Iliana Doycheva
- Division of Gastroenterology and Hepatology, Medical University-Sofia, 1 G. Sofiisky Boulevard, Sofia 1431, Bulgaria
| | - Syed Amer
- Division of Internal Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, CH-10, 200 First Street Southwest, Rochester, MN 55905, USA.
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Katabathina V, Menias CO, Pickhardt P, Lubner M, Prasad SR. Complications of Immunosuppressive Therapy in Solid Organ Transplantation. Radiol Clin North Am 2016; 54:303-19. [DOI: 10.1016/j.rcl.2015.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Schmalzing M, Krockenberger M, Honig A, Tony H. Gynäkologische Malignome bei Patientinnen mit rheumatisch‑entzündlichen Systemerkrankungen. Z Rheumatol 2016; 75:63-7. [DOI: 10.1007/s00393-016-0044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Das Risiko für gynäkologische Tumoren bei rheumatisch-entzündlichen Systemerkrankungen scheint nur in Bezug auf das Zervixkarzinom v. a. bei systemischem Lupus erythematodes erhöht zu sein. Studien weisen auf die Bedeutung des Immunsystems für die Tumorkontrolle bei gynäkologischen Tumoren hin. Bislang konnte aber nur für das Zervixkarzinom ein ungünstiger Einfluss einer medikamentösen Immunsuppression bei rheumatologischen Patientinnen gezeigt werden. Biologika wirken sich bei dieser Entität dagegen nicht eindeutig tumorfördernd aus. Die Datenlage bei dieser Fragestellung ist allerdings begrenzt. Generelle Screeningempfehlungen existieren für das Mammakarzinom und das Zervixkarzinom. Empfehlungen zur Tumornachsorge werden dargestellt. Aufgrund der unzureichenden Datenlage empfiehlt sich zumindest in den ersten 5 Jahren nach kurativer onkologischer Therapie eine sehr strenge Indikationsstellung zum Einsatz von Immunsuppressiva und Biologika auch bei gynäkologischen Tumoren. Im Falle des Mammakarzinoms wird sogar die Beachtung eines längeren Intervalls diskutiert.
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Ormerod E, de Berker D. Nail unit squamous cell carcinoma in people with immunosuppression. Br J Dermatol 2015; 173:701-12. [DOI: 10.1111/bjd.13860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 12/12/2022]
Affiliation(s)
- E. Ormerod
- Bristol Dermatology Centre; Bristol University Hospitals NHS Trust; Bristol Royal Infirmary; Bristol BS2 8HW U.K
| | - D. de Berker
- Bristol Dermatology Centre; Bristol University Hospitals NHS Trust; Bristol Royal Infirmary; Bristol BS2 8HW U.K
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Management of de novo malignancies after liver transplantation. Transplant Rev (Orlando) 2015; 29:38-41. [DOI: 10.1016/j.trre.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 12/19/2022]
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Clinical spectrum of cutaneous manifestations in renal and renopancreatic recipients in two centers in Uruguay. Transplant Proc 2014; 46:3047-9. [PMID: 25420819 DOI: 10.1016/j.transproceed.2014.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Uruguay, with a total population of 3,345,000 inhabitants, is the Latin American country with the second highest number of renal replacement therapies. Long-term immunosuppressant therapy is essential for graft survival but results in reduced immunosurveillance, leading to an increased risk of complications. A variety of dermatological manifestations and a large increase in nonmelanoma skin cancers have been reported in this population. The purpose of this study was to evaluate the frequency and clinical spectrum of cutaneous manifestations in renal and renopancreatic recipients in 2 reference centers in Uruguay. Two hundred and six renal or renopancreatic recipients between 21 and 77 years old were evaluated between September 2009 and September 2011. A total of 206 dermatoses were observed; 60% of the patients had at least 1 cutaneous manifestation. The most frequent dermatoses were cutaneous side effects due to immunosuppressive treatment (40.6%), followed by infections (26.1%), miscellaneous causes (18.9%), and malignant and premalignant lesions (14.4%). Transplant recipients represent a high-risk dermatological population. Physicians in transplant units should be aware of the importance of dermatological screening in order to promote early detection of skin cancer.
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Prevalence and Genotypes of HPV in Female Renal Transplant Recipients in North India. Int J Gynecol Pathol 2014; 33:537-42. [DOI: 10.1097/pgp.0b013e3182a54ada] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Many transplant recipients are not protected against vaccine-preventable illnesses, primarily because vaccination is still an underutilized tool both before and after transplantation. This missed opportunity for protection can result in substantial morbidity, graft loss and mortality. Immunization strategies should be formulated early in the course of renal disease to maximize the likelihood of vaccine-induced immunity, particularly as booster or secondary antibody responses are less affected by immune compromise than are primary or de novo antibody responses in naive vaccine recipients. However, live vaccines should be avoided in immunocompromised hosts. Although some concern has been raised regarding increased HLA sensitization after vaccination, no clinical data to suggest harm currently exists; overall, non-live vaccines seem to be immunogenic, protective and safe. In organ transplant recipients, some vaccines are indicated based on specific risk factors and certain vaccines, such as hepatitis B, can protect against donor-derived infection. Vaccines given to close contacts of renal transplant recipients can provide an additional layer of protection against infectious diseases. In this article, optimal vaccination of adult transplant recipients, including safety, efficacy, indication and timing, is reviewed.
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Improved clearance during treatment of HPV-positive head and neck cancer through mTOR inhibition. Neoplasia 2014; 15:620-30. [PMID: 23730210 DOI: 10.1593/neo.13432] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Abstract
Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) incidence is increasing at a near epidemic rate. We investigated whether the mammalian (or mechanistic) target of rapamycin (mTOR) inhibitor, rapamycin, can be used as a concurrent agent to standard-of-care cisplatin/radiation therapy (CRT) to attenuate tumor lactate production, thus enhancing CRT-induced immune-mediated clearance of this antigenic tumor type. A C57Bl/6-derived mouse oropharyngeal epithelial cell line retrovirally transduced with HPV type 16 E6/E7 and human squamous cell carcinoma cell lines were evaluated for their response to rapamycin in vitro with proliferation assays, Western blots, and lactate assays. Clonogenic assays and a preclinical mouse model were used to assess rapamycin as a concurrent agent to CRT. The potential of rapamycin to enhance immune response through lactate attenuation was assessed using quantitative tumor lactate bioluminescence and assessment of cell-mediated immunity using E6/E7-vaccinated mouse splenocytes. Rapamycin alone inhibited mTOR signaling of all cancer cell lines tested in vitro and in vivo. Furthermore, rapamycin administered alone significantly prolonged survival in vivo but did not result in any long-term cures. Given concurrently, CRT/rapamycin significantly enhanced direct cell killing in clonogenic assays and prolonged survival in immunocompromised mice. However, in immunocompetent mice, concurrent CRT/rapamycin increased long-term cures by 21%. Preliminary findings suggest that improved survival involves increased cell killing and enhanced immune-mediated clearance in part due to decreased lactate production. The results may provide rationale for the clinical evaluation of mTOR inhibitors concurrent with standard-of-care CRT for treatment of HPV-positive HNSCC.
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Schuurman M, van den Einden L, Massuger L, Kiemeney L, van der Aa M, de Hullu J. Trends in incidence and survival of Dutch women with vulvar squamous cell carcinoma. Eur J Cancer 2013; 49:3872-80. [DOI: 10.1016/j.ejca.2013.08.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/10/2013] [Accepted: 08/01/2013] [Indexed: 01/20/2023]
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Intra-abdominal localisation of a buschke-lowenstein tumour: case presentation and review of the literature. Case Rep Transplant 2013; 2013:187682. [PMID: 24159412 PMCID: PMC3789409 DOI: 10.1155/2013/187682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/26/2013] [Indexed: 11/17/2022] Open
Abstract
Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.
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50
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Adey DB. Women and kidney transplantation. Adv Chronic Kidney Dis 2013; 20:427-32. [PMID: 23978549 DOI: 10.1053/j.ackd.2013.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 12/22/2022]
Abstract
Kidney transplant is the best kidney replacement treatment for end-stage kidney disease. The first step in moving toward kidney transplantation is referral to a transplant center for transplant evaluation. Education of dialysis staff and health-care providers may help increase referrals for evaluation. Patient education has been shown to enhance patient completion of the evaluation process. Patients have difficulty asking others to donate a kidney, but this process can be improved with home and community education. Living donors are more likely to be women than men, especially spousal donors. Deceased donors are more likely to be males younger than 35 years of age. There is a slight decrease in the rate of transplantation of women as compared with men, although not statistically significant. Pretransplant development of anti-human leukocyte antigen antibodies is more common amongst women and can be a barrier to successful transplantation and may prolong the waiting time for transplant. The long-term management of cardiovascular risk factors, osteoporosis, and age-appropriate cancer screening need to be addressed with posttransplant recipients. Women have an overall increased patient and graft survival as compared with men after transplant.
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