Risk of human papillomavirus-related cancers among kidney transplant recipients and patients receiving chronic dialysis - an observational cohort study

Abstract

BackgroundIndividuals with end-stage renal disease (ESRD) have excess risk of various cancer types. However, the total burden of human papillomavirus-related cancers remains unknown.MethodsWe performed a nationwide observational cohort study during 1994–2010.For each person with ESRD, we sampled 19 population controls (without ESRD) matched on age, gender and municipality. Participants were followed until first diagnosis of human papillomavirus-related cancer, death, emigration, or 31 December 2010, whichever came first.Human papillomavirus-related cancers were extracted from Danish medical administrative databases. We considered cancers of the cervix, vulva, vagina, penis, anus, and subsets of head and neck cancers as human papillomavirus-related. We calculated incidence rates of human papillomavirus-related cancer and used Poisson regression to identify risk factors for human papillomavirus-related cancer.ResultsAmong 12,293 persons with ESRD and 229,524 population controls we identified 62 and 798 human papillomavirus-related cancers, respectively. Incidence rates of human papillomavirus-related- cancer were 102 per 100,000 person-years (95% confidence interval [CI]; 79.5-131) among persons with ESRD and 40.8 per 100,000 person-years (95% CI; 38.1-43.7) among population controls. ESRD patients had 4.54 (95% CI, 2.48-8.31) fold increased risk of anal cancer and 5.81 fold (95% CI; 3.36-10.1) increased risk of vulvovaginal cancer. Adjusted for age, comorbidity, and sex, ESRD patients had 2.41 (95% CI; 1.83-3.16) fold increased risk of any human papillomavirus-related cancer compared with population controls. Compared with dialysis patients renal transplant recipients had an age-adjusted non-significant 1.53 (95% CI, 0.91-2.58) fold higher risk of human papillomavirus-related cancer.ConclusionsPersons with ESRD have excess risk of potentially vaccine-preventable human papillomavirus-related cancers.

Human papillomavirus‐related anogenital premalignancies and cancer in renal transplant recipients: A Danish nationwide, registry‐based cohort study

“…These results are in accordance with previous population‐based registry studies reporting an increased rate of cervical cancer and other HPV‐related anogenital cancers in RTRs compared to the general population. While most of the previous studies were based on calculation of standardized incidence ratios, we were able to adjust for potential confounders, including socioeconomic characteristics, HPV vaccination, HIV/AIDS and other solid organ transplants.…”

“…Virtually all cervical cancers and approximately 80–90% of anal squamous cell carcinomas (SCCs), 70% of vaginal SCCs, 40% of vulvar SCCs and 50% of penile SCCs are estimated to be caused by HPV. Several large, population‐based registry studies have found that RTRs have an increased risk of HPV‐associated anogenital cancers compared to the general population . It has been hypothesized that the immunosuppressive treatments received by RTRs decrease their ability to clear newly acquired HPV infections and/or increase their risk of reactivation of latent HPV infections .…”

“…Previous population‐based registry studies of HPV‐related disease in RTRs focused only on HPV‐related cancers, whereas none of the studies investigated the risk of HPV‐related premalignancies in RTRs. Knowing the risk of premalignancies is important in order to assess the total HPV‐related disease burden in RTRs, and to estimate the potential impact of HPV vaccination and screening for HPV‐related premalignancies in this patient group.…”

“…Several large, populationbased registry studies have found that RTRs have an increased risk of HPV-associated anogenital cancers compared to the general population. [8][9][10][11][12][13][14][15][16][17][18] It has been hypothesized that the immunosuppressive treatments received by RTRs decrease their ability to clear newly acquired HPV infections and/or increase their risk of reactivation of latent HPV infections. 19,20 In accordance with this hypothesis, an Australian registry study found that the risk of HPV-related cancers in RTRs was higher during periods of functioning graft than during periods of dialysis where immunosuppressive treatment is withdrawn or substantially reduced.…”

“…19,20 In accordance with this hypothesis, an Australian registry study found that the risk of HPV-related cancers in RTRs was higher during periods of functioning graft than during periods of dialysis where immunosuppressive treatment is withdrawn or substantially reduced. 12 Previous population-based registry studies of HPV-related disease in RTRs focused only on HPV-related cancers, [8][9][10][11][12][13][14][15][16][17][18] whereas none of the studies investigated the risk of HPV-related premalignancies in RTRs. Knowing the risk of premalignancies is important in order to assess the total HPV-related disease burden in RTRs, and to estimate the potential impact of HPV vaccination and screening for HPV-related premalignancies in this patient group.…”