title: Anogenital malignancies in women after renal transplantation over 40 years in a single center.
abstract: BACKGROUND
  Renal transplant recipients have an increased risk to develop human papillomavirus (HPV)-related anogenital malignancies. A clinical overview of female anogenital posttransplantation malignancies and possible multifocal premalignancies over a period of 40 years renal transplantation is presented. Additionally, the genotype-specific prevalence of HPV in these (pre)malignancies was investigated.
  
  
  METHODS
  Data of 1023 women, who underwent a renal transplantation between 1968 and 2008, were collected. Clinical data of all female renal transplant recipients who developed anogenital malignancies were retrospectively analyzed. The histology, cytology, and distribution of genotype-specific HPV infections were analyzed in all primary anogenital tumors and possible (multifocal) premalignancies.
  
  
  RESULTS
  Sixteen anogenital malignancies (1.6%) were found: vulva (n=6), cervix (n=5), and anus (n=5). Twelve of 16 patients never had a cervical smear before transplantation. The median interval between transplantation and diagnosis of malignancy was 136 months (range, 16-288 months). High-risk HPV was detected in 91.7% of investigated lesions, HPV subtype 16 predominated (54.5%). Four of seven patients with two distinct anogenital lesions had different HPV types in the lesions.
  
  
  CONCLUSIONS
  A high number of anogenital malignancies developed in our cohort, which are nearly all caused by HPV. Multifocal lesions within one patient frequently contained different high-risk HPV genotypes in both lesions. Our results underline the importance of anogenital screening and monitoring before and periodically after renal transplantation to prevent morbidity and mortality from anogenital malignancies.
authors.affiliation: Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. k.meeuwis@derma.umcn.nl
authors.forename: Kim A P
authors.initials: KA
authors.lastname: Meeuwis
authors.forename: Willem J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: Hanneke
authors.initials: H
authors.lastname: Bouten
authors.forename: Peter C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.forename: Floor
authors.initials: F
authors.lastname: Hinten
authors.forename: Wim G V
authors.initials: WG
authors.lastname: Quint
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: Michelle M
authors.initials: MM
authors.lastname: van Rossum
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult