Human papillomavirus‐related cancer risk for solid organ transplant recipients during adult life and early prevention strategies during childhood and adolescence

Abstract

Malignancies are among the top three causes of patient death in pediatric and adult kidney transplant (KT) recipients according to the North American Pediatric Renal Trials and Collaborative Studies 2014 Annual Report and the U.S. Renal Data System 2020 Annual Data Report. Transplant professionals know their patients walk a tightrope, being potential victims of either underimmunosuppres-sion that leads to rejection on one side, or overimmunosuppression that leads to infections and malignancies on the other side. 1 Indeed, solid organ transplant (SOT) recipients experience more cancer compared with the general population. For example, KT recipients experience a 14-fold increased risk of cervical cancer, a 50-fold increased risk of vulvar cancer, and a 100-fold increased risk for anal cancers. 2,3 In addition, male SOT recipients have an increased risk for penile cancers. 4 Population-based cohort studies of SOT recipients have shown an increased risk of HPV-associated cancers: standardized incidence ratios have been shown to be 2.13 for cervical, anal, and oropharyngeal cancers, respectively, relative to

Human papillomavirus infection-related cancer risk for kidney transplant recipients during adult life can be reduced by vaccination during childhood and adolescence

“…Surprisingly, a recent study of children with CKD showed that growth and sexual maturation are only slightly delayed compared to healthy subjects, which is contrary to what it was previously thought (4, 71), therefore it is important that they are administered the HPV vaccine without delays (60). In general, routine pediatric immunizations in KT candidates and recipients are more likely to be administered by their primary care providers, while vaccines that differ from the routine schedules, including the HPV, are more likely to be administered by transplant professionals, who are likely to be more familiar with dosing them appropriately (4,67). Thus, it is important for both general pediatricians and pediatric transplant nephrologists to be aware of the immunization guidelines for KT candidates and recipients and stay in close communication, to ensure an ongoing fully immunized status for their patients (4).…”

“…Worldwide, the estimated lifetime probability of being infected is greater than 80% for women and 90% for men ( 12 ). Certain types, including HPV 16, −18, −31, −33, −35, −39, −45, −51, −52, −56, −58 and −59, are responsible for greater than 95% of HPV-related cancers ( 4 , 13 ). HPV has been identified as a cause for cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers in >91%, 75%, 69%, 63%, 91% and 70%, respectively ( 4 , 14 ).…”

“…Certain types, including HPV 16, −18, −31, −33, −35, −39, −45, −51, −52, −56, −58 and −59, are responsible for greater than 95% of HPV-related cancers ( 4 , 13 ). HPV has been identified as a cause for cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers in >91%, 75%, 69%, 63%, 91% and 70%, respectively ( 4 , 14 ). Of all the HPV-related malignancies, cervical carcinoma, which is linked to HPV in over 90% of the cases, deserves a special consideration, as it is the second most common cancer and cause of cancer death in women at international level ( 4 , 14 ).…”

“…Overall, the cancer rate in adults who received a KT as children was six times higher compared to general population ( 3 ). As an example, female KT recipients have a 14-fold increased risk of cervical cancer and a 50-fold increased risk of vulvar cancer, male KT recipients have an increased risk for penile cancers and both female and male KT recipients have a 100-fold increased risk for anal cancers ( 4 – 7 ). The common denominator for all these cancer types is the infection with different types of human papillomavirus (HPV) ( 8 ).…”

“…Understanding that adult KT patients carry a high-risk for cancers, including HPV-related ones, and that the treatment for these diseases can negatively impact the graft viability and life expectancy , medical professionals need to get an early start with the most efficacious preventive strategies during childhood and adolescence ( 4 ). This article will delineate the most efficient primary prevention strategy, the HPV vaccination, which applied by pediatric professionals during childhood and adolescence has been proven to reduce the risk for HPV-associated malignancies for KT recipients during their adult life ( 9 , 10 ).…”