Anal dysplasia among solid organ transplant recipients; a cross sectional study

Abstract

Introduction The incidence of anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of anal dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing anal dysplasia. Methods and materials Patients presenting to transplant office for routine care were recruited to participate in the study. All anal cytology specimens were collected using standard anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of anal dysplasia among our subjects was obtained. Results Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any analysis. Dysplastic cells were found in 10.5% of the specimens available for analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with anal dysplasia versus those without anal dysplasia. Conclusions The rate of anal dysplasia detectable on cytology is high enough to warrant anal dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of anal dysplasia mandating screening continues to be a challenge.

Burden of anal squamous cell carcinoma, squamous intraepithelial lesions and HPV16 infection in solid organ transplant recipients: A systematic review and meta-analysis

“…Four studies were in a kidney transplant cohort, 25,27,28 1 was in a liver transplant cohort, 30 and 1 in a mixed cohort of kidney, pancreas, and liver transplants 29 . Of note, all studies had unsatisfactory sample rates lower than 15%, except the study by Khan et al 29 with an unsatisfactory sample rate of 19% (data not shown).…”

“…Six studies and a total of 328 satisfactory samples were included in final analyses (Figures 1C and 3B; Table S5). Two studies were conducted in the United States 28,29 and 1 each in the United Kingdom, 25 Portugal, 30 Australia, 16 and Brazil 27 all using liquid‐based cytology. Four studies were in a kidney transplant cohort, 25,27,28 1 was in a liver transplant cohort, 30 and 1 in a mixed cohort of kidney, pancreas, and liver transplants 29 .…”

“…Two studies were conducted in the United States 28,29 and 1 each in the United Kingdom, 25 Portugal, 30 Australia, 16 and Brazil 27 all using liquid‐based cytology. Four studies were in a kidney transplant cohort, 25,27,28 1 was in a liver transplant cohort, 30 and 1 in a mixed cohort of kidney, pancreas, and liver transplants 29 . Of note, all studies had unsatisfactory sample rates lower than 15%, except the study by Khan et al 29 with an unsatisfactory sample rate of 19% (data not shown).…”

“…35 All studies that were included had unsatisfactory sample rates lower than 15% except 1. 29 When considering histological ASIL only studies using HRA were included. HRA is the F I G U R E 2 Forest plots of (A) the standardized incidence ratio (SIR) and (B) the incidence rate (IR) for anal squamous cell carcinoma in solid organ transplant recipients in individual studies (•) with summary estimates from our metaanalysis (◆) ing.…”

“…A rate of less than 5% of unsatisfactory samples on anal cytology in high‐risk groups (eg, HIV‐positive MSM) and <15% in lower‐risk groups (eg, HIV‐negative women) has been recommended 35 . All studies that were included had unsatisfactory sample rates lower than 15% except 1 29 . When considering histological ASIL only studies using HRA were included.…”