title: Risk of human papillomavirus-related cancers among kidney transplant recipients and patients receiving chronic dialysis--an observational cohort study.
abstract: BACKGROUND
  Individuals with end-stage renal disease (ESRD) have excess risk of various cancer types. However, the total burden of human papillomavirus-related cancers remains unknown.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  Persons with ESRD have excess risk of potentially vaccine-preventable human papillomavirus-related cancers.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark. larsdalg@rm.dk
authors.forename: Lars
authors.initials: L
authors.lastname: Skov Dalgaard
authors.forename: Ulrik
authors.initials: U
authors.lastname: Fassel
authors.forename: Lars Jørgen
authors.initials: LJ
authors.lastname: Østergaard
authors.forename: Bente
authors.initials: B
authors.lastname: Jespersen
authors.forename: Ole
authors.initials: O
authors.lastname: Schmeltz Søgaard
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D014625:Vaginal Neoplasms / Q000453:epidemiology* / Q000628:therapy; D014846:Vulvar Neoplasms / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult