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

Abstract

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.

British Association of Dermatologists’ guidelines for the safe and effective prescribing of azathioprine 2011

“…There is some debate whether immunosuppressed patients should be screened more frequently, and in some European centres annual cytology combined with colposcopy is recommended 139 . Data from the renal transplant population (receiving multiple immunosuppressive agents) suggests a fivefold increase in the prevalence of abnormal cervical cytology (15%) above the normal population 140 . However, there is no information on risk in dermatology patients on single immunosuppressant drugs such as azathioprine.…”

Gynecologic follow up of 129 women on dialysis and after kidney transplantation: a retrospective cohort study

“…A retrospective study described the cervical screening of 144 transplant recipients; the overall incidence of abnormal cytology was 17.3%, and histopathology identified 6.9% of CIN I and CIN II, and 2.1% of CIN III [13]. Moreover, a nationwide populationbased retrospective cohort study set up in Australia showed that standardized incidence ratios for cancers associated with human papillomavirus infection, notably anogenital cancers (RR = 5.96; CI95% 3.93-8.67), were significantly elevated during transplant function, but not during dialysis [15].…”

“…This may, however, increase the incidence of diseases associated with human papillomavirus infection, such as cervical intraepithelial neoplasia and cervical cancer [13][14][15]. Systematic annual cervical screening should therefore be advised.…”

High risk type human papillomavirus indicates increasing high grade intraepithelial lesion incidence in cytological low grade squamous intraepithelial lesion patients

“…It is known that LSILs are related to low risk HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81 and HSILs and cervical cancers are related to high risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. But some cervical intraepithelial neoplasia 2 (CIN 2) and 3 lesions develop without a preexisting CIN 1 [5,6]. And HPVs are positive in CIN 1 about 85% [7,8].…”

“…And HPVs are positive in CIN 1 about 85% [7,8]. Some CIN 1s and almost all CIN 2 and 3 lesions are associated with monoclonal "high-risk" HPV types [5,9]. For clinical convenience, cytological LSIL should be proven as pathological LSIL and cytological HSIL should be proven as pathological HSIL.…”