Human papillomavirus infections in a group of renal transplant recipients

Abstract

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.

Prevalence of human papillomavirus DNA in cutaneous neoplasms from renal allograft recipients supports a possible viral role in tumour promotion

“…Moreover, all 15 positive specimens in that study came from four patients at exceptionally high risk of development of cutaneous lesions, each of whom had multiple SCCs. The balance of evidence now suggests that HPV 5 and 8 DNA is found relatively infrequently in tumours from RARs (Lutzner et al, 1980(Lutzner et al, , 1983Rudlinger et al, 1986;Van der Leest, 1987;Soler et al, 1992).…”

“…By contrast, investigation of the relationship between HPV and cutaneous cancers in RARs has been inconclusive with regard to both prevalence and type of HPV DNA detected. This may be the result of differences in sample size studied or differences in sensitivity and specificity of the detection (Lutzner et al, 1980(Lutzner et al, , 1983Rudlinger et al, 1986;Jablonska et al, 1987;Van der Leest, 1987;Blessing et al, 1989;Euvrard et al, 1991). An additional factor in some studies may be the inclusion of a large proportion of patients who seem to be at exceptionally high risk of developing multiple and widespread premalignant and malignant cutaneous lesions with increased HPV DNA content .…”

Cervical intraepithelial neoplasia in lymphoma patients: a cytological and colposcopic study

“…We also looked for evidence of cervical human papillomavirus (HPV) infection in these patients, in view of the continuing debate concerning the role of this virus in cervical malignancy (Anonymous, 1985a). There is some evidence that immunosuppression may lead to the malignant conversion of papillomavirus induced lesions in animals (Campo & Jarrett, 1987) and in man (Sillman et al, 1984;Rudlinger et al, 1986;Schneider et al, 1983 Table IV shows that the lymphoma patients with cervical koilocytosis without CIN were older, more likely to be parous and became sexually active rather later than the patients in whom no significant abnormality was detected. They also had had their lymphomas diagnosed for longer periods.…”

Proliferative T cell responses to human papillomavirus type 16 L1 peptides in patients with cervical dysplasia

“…These include the spontaneous regression of skin warts after a monomlclear cell infiltrate of the dermis and epidermis (Tagami et al, 1993) and an increased incidence of HPV-related lesions of the skin and genital tract in patients with impaired cell-mediated immunity, as in the genetically determined disorder epidermodysplasia verruciformis (Orth, 1987). Immunosuppressed allograft recipients have an increased incidence of skin warts (Rudlinger et aL, 1986), genital warts and CIN (Porreco et al, 1975). In addition, in immunocompromised individuals infected with human immunodeficiency virus, HPV-16 and -18 have been isolated more frequently (Melbye et al, 1990;Johnson et al, 1992).…”