COMMENTARY

Screening Transplant Recipients for Lower Genital Tract Dysplasia

Andrew M. Kaunitz, MD

Disclosures

August 20, 2019

This transcript has been edited for clarity.

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville.

The number of women undergoing solid organ transplants, including kidney, liver, lung, and heart, continues to increase, meaning that we will be seeing more and more patients who are transplant recipients.

The great majority of lower genital tract cancers are caused by persistent high-risk human papillomavirus (HPV). The use of immunosuppressive medications, which reduces HPV clearance, places transplant recipients at elevated risk.

Investigators at an urban US academic medical center followed a cohort of women who underwent solid organ transplant between 2000 and 2015.[1] Among almost 400 recipients, the median age at transplant was 41 years. During a median follow-up of almost 8 years, some 12% of the cohort were found to have lower genital tract dysplasia. Although most dysplasia was cervical, preinvasive vaginal, vulvar, and anal disease was also found.

Of 38 transplant recipients with cervical dysplasia, 14 were diagnosed with cervical intraepithelial neoplasia (CIN) 2 or worse, and one woman was diagnosed with invasive cancer. The median time to diagnosis of CIN 2 or worse after transplant was 4 years.

Nineteen women were found to have noncervical dysplasia; 13 of these were diagnosed with high-grade changes or worse, including three cases of invasive cancer of the anus, and one each of vulvar and vaginal cancer.

This important study provides convincing evidence of a high risk for preinvasive lower genital tract disease in solid organ transplant recipients. I agree with the authors' recommendations that we should annually screen such women for cervical cancer while evaluating the entire lower genital tract.

Thank you for the honor of your time. I am Andrew Kaunitz.

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