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Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients

Thimm, Matthew A. MD; Rositch, Anne F. PhD, MSPH; VandenBussche, Christopher MD, PhD; McDonald, Lynn DNP; Garonzik Wang, Jacqueline M. MD, PhD; Levinson, Kimberly MD, MPH

doi: 10.1097/AOG.0000000000003378
Contents: Dysplasia: Original Research
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OBJECTIVE: To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development.

METHODS: This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia.

RESULTS: Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29–53). Forty-seven (11.9%; 95% CI 8.8–15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6–12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33–6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96–18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years.

CONCLUSIONS: One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.

Yearly lower genital examination should be performed in transplant recipients owing to the increased risk of dysplasia in this population.

Johns Hopkins University School of Medicine, the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, the Departments of Pathology, Gynecology and Obstetrics, and Surgery, and the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Corresponding author: Kimberly Levinson, MD, MPH, the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD; email: klevins1@jhmi.edu.

Financial Disclosure Christopher VandenBussche reports receiving money paid to his institution from Sienna Cancer Diagnostics, Personal Genome Diagnostics, and Springer Publishing. The other authors did not report any potential conflicts of interest.

Presented at the International Papillomavirus Conference, October 2–6, 2018, Sydney, Australia.

The authors thank Regina Kwon, MD, for assistance with data management and Bonnie Williamson, CT (ASCP), for assistance with data collection.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B450.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.