Cancer in organ transplant recipients: part of an induced immune deficiency syndrome.

Sheil, A. G. R.

doi:10.1136/bmj.288.6418.659

Cited by 38 publications

(9 citation statements)

References 9 publications

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“…The finding that 48'^,, of the patients suffered from warts is similar to previous reports (Spencer & Andersen, 1979;Boyle etal, 1984). The effect of graft survival time upon the onset of warts and skin lesions, already observed by Sheil (1984), was well illustrated in this study, in which the prevalence rose from 15" " at the end of the first year to 87" " after the fifth year. This difference is in fact even greater as the presence of warts at the time of transplant represents a larger proportion of the warts in tbe early group than in the late group; 5",, of patients in the early group had new warts, and 80",, in the late group.…”

Section: Discussionsupporting

confidence: 79%

Human papillomavirus infections in a group of renal transplant recipients

et al. 1986

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One hundred and twenty renal transplant recipients were investigated. Fifty-eight (48%) were found to have warts, 13 (11%) keratoses and six (5%) to have, or recently to have had cancers. The longer the time of immunosuppression, the greater the prevalence of warts; of those patients who had had their transplant for at least 5 years, 87% had warts. Those with a graft survival time of 10 years or more are at special risk of warts, keratoses and malignancy. Five (10%) of 50 women had genital warts, four of whom had internal lesions (vaginal, cervical or anal) and one developed a carcinoma of the vulva. These findings indicate the advisability of colposcopy for all female renal transplant recipients, a high risk group. Eighty-eight specimens from 42 patients were examined by DNA restriction enzyme analysis and cross hybridization for the presence and type of human papillomavirus (HPV). HPV DNA was detected in 66% of the warts examined, HPV2 and HPV4 occurring most often and HPV1 and HPV3 only infrequently. In sequential specimens from common hand warts of one individual, an HPV was found which could not be precisely identified but was related to HPV4. HPV16 was detected in a vaginal wart from one patient and an HPV6-related virus in a vulval wart of another. HPV DNA of an unknown type was demonstrated in one of 11 keratoses examined. With the probes used to examine the few samples of skin cancers available, HPV16 was found in a squamous cell carcinoma of the vulva, and faint bands from an unidentified type of HPV were detected in two squamous cell carcinomata from a patient's hand. One woman had plaque lesions morphologically and histologically resembling those found in epidermodysplasia verruciformis (EV). HPV5 was identified in these lesions. This is only the third reported case of HPV5, previously thought to be unique to EV, in a renal transplant recipient.

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Section: Discussionsupporting

confidence: 79%

Human papillomavirus infections in a group of renal transplant recipients

et al. 1986

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“…Several theories have been suggested to explain the high incidence of abnormal smears. Sheil (1984) stresses the important role of the induced immunosuppressive state of the renal transplant patient. As human papillomavirus may play a major role in the development of cervical neoplasia, a possible explanation would be an increased infection rate of renal transplant patients with oncogene human papillomavirus, as is found in patients positive for the human immunodeficiency virus (Williams et al 1994).…”

Section: Discussionmentioning

confidence: 99%

The incidence of cervical intraepithelial neoplasia among women with renal transplant in relation to cyclosporine

Eck

Rischen-Vos

Chadha-Ajwani

et al. 1995

BJOG

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Objective To evaluate the policy of an annual smear to screen renal transplant recipients for cervical intraepithelial neoplasia and invasive carcinoma and to determine the incidence of abnormal smears and CIN before and after the introduction of cyclosporine (1983). Design A retrospective study over the period 1971 to 1992. Subjects Postmenarchial women who received renal transplants and who were on immuno‐suppressive treatment for at least one month. Mean outcome measures Cytology and histology results. Results A total of 144 women who received renal transplantation were eligible for our study. Observation time varied from 1 to 227 months (median 59 months) with a mean for the group transplanted before 1983 (Group A) of 103 months, and for the group transplanted after 1983 (Group B) of 46 months. Of these women, 25 had an abnormal smear. Of these, 14 were confirmed by histology and repeated smears of the other 11 patients were negative. Within the 60 women in Group A with an abnormal smear, six had CIN I or CIN II, three had CIN III and one showed adenocarcinoma of the endometrium. Among the 84 women in Group B, four had CIN I or CIN II and none had CIN III. The overall incidence of abnormal cytology was 17.3%, with no invasive cervical carcinoma in this group. Conclusions Our policy of screening is adequate. With the introduction of cyclosporine the incidence of abnormal cytology and histology has a tendency to decrease. However, the duration of risk is not comparable yet.

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“…Antirejection medications induce a state of iatrogenic depression of immune surveillance, suggested to be a condition permissive for the development of malignancy. 18,27,28 However, it also was suggested that such immunosuppressive agents as azathioprine 29,30 and CyA 31 have intrinsic properties that favor the establishment of de novo malignancies. Potential mechanisms range from inherent carcinogenic properties of antiproliferative agents to alterations in the cytokine milieu associated with CyA (and perhaps tacrolimus) to an independent effect on cell-adhesive properties.…”

Section: Role Of Immunosuppressionmentioning

confidence: 99%