Brief communication
Sexual health issues after lung transplantation: importance of cervical screening

https://doi.org/10.1016/j.healun.2003.07.018Get rights and content

Abstract

To determine the incidence and outcomes of human papillomavirus infection and cervical abnormalities after lung transplantation, we performed a retrospective cross-sectional study of all 166 female recipients who underwent transplantation between February 1989 and June 2001 at our institution. The incidence of low-grade epithelial abnormality of the cervix, cervical intra-epithelial neoplasia (CIN) 1, and the earliest pre-cancerous changes of the cervical epithelial cells, CIN 3, in the post-transplant cohort was 42.2 and 30, respectively, per 1,000 women screened compared with 8.3 and 6.2 per 1,000 women screened (20–69 years old) in a large reference population. We conclude that the incidence of cervical abnormalities in lung transplant recipients is significantly greater than in the general population. The importance of regular surveillance in immunosuppressed patients to decrease the burden of disease from this potentially fatal but treatable condition is emphasized.

Section snippets

Methods

We performed a retrospective cross-sectional study of all female lung transplant recipients who underwent transplantation between February 1989 and June 2001. Forty-six percent of lung transplant recipients at our institution were women. Papanicolaou (Pap) smears were performed in all female patients as part of our routine workup for transplantation if patients were ≥18 years or were sexually active. Our policy has been to recommend annual Pap smears after transplantation. All patients with

Results

Seventeen of 166 patients (10.2%) experienced cervical abnormalities at post-operative Day 957 ± 533 (range, 122–2,030). The mean age for these 17 patients was 39 ±13 (range, 23–56) years. Abnormalities included CIN 1 (n = 7), CIN 2 (n = 3), CIN 3 (n = 3), and HPV alone (n = 4). One patient with CIN 3 also had co-existing vulval intra-epithelial neoplasia Grade 3. Successful treatment included colposcopy and therapeutic cone biopsy (n = 3), Letz loop (n = 4), laser (n = 3), diathermy (n = 2),

Discussion

Human papillomavirus infection is one of the most prevalent sexually transmitted diseases. A strong correlation exists between high-risk HPV sub-types (16, 18, 31, 35, and 39) and high-grade CIN and the subsequent development of invasive carcinoma.9, 10 In non-immunosuppressed women, the mean age of women with CIN is approximately 15 years younger than that of women with invasive cancer, suggesting slow progression of CIN to invasive carcinoma.11

A large prospective study by Richart and Barron12

Conclusions

Although the impact of immunosuppression on the development of cervical dysplasia or on the rate of progression to invasive cervical cancer in lung transplant recipients is unknown, impaired clearance of the virus probably exists because of immunosuppression. Our data suggest that the incidence of cervical abnormalities in lung transplant recipients is significantly greater than in the general population.

The importance of regular surveillance in immunosuppressed patients to allow early

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