Anal cancer in renal transplant patients.
OBJECTIVE
A comprehensive literature review was performed to examine the prevalence of anal cancer, anal intraepithelial neoplasia (AIN) and anal human papillomavirus (HPV) infection in renal transplant recipients who are at risk of anal cancer due to iatrogenic immunosuppression.


METHODS
Pertinent articles were identified from searches performed on the National Center for Biotechnology Information database using the following keywords: anal cancer, AIN, screening, renal transplant (or kidney transplant), organ transplant recipients and post-transplant malignancies.


RESULTS
The prevalence of AIN is 20% in renal transplant patients. The prevalence of anal HPV infection in established transplant patients is 47%, and the prevalence of anal HPV infection in new transplant patients is 23%. The relative risk for anal cancer in renal transplant patients is 10.


CONCLUSIONS
As compared to HIV-positive male patients who practise anal intercourse, renal transplant patients showed a modest rise in relative risk for anal cancer. Screening programmes to detect AIN in HIV-positive patients who practise anal intercourse have been introduced on a preliminary basis in sexual health clinics in the US and may become standard practise in this population. The case for screening in renal transplant patients is unclear and would merit further investigation, especially with reference to the prevalence of anal HPV infection in this population. It may transpire that renal transplant patients would benefit more from HPV prophylaxis rather than screening for AIN.
Patel
Heena S
HS
Colorectal Cancer Unit, Cancer Research UK, Level 5, St. Mark's Hospital, Harrow, Middlesex, HA1 3UJ, UK. heena2001@doctors.org.uk
Silver
Andrew R J
AR
Northover
John M A
JM
D001004:Anus Diseases / Q000453:epidemiology / Q000821:virology; D001005:Anus Neoplasms / Q000453:epidemiology / Q000209:etiology*; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology*; D006084:Graft Rejection / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors
D007166:Immunosuppressive Agents