title: Papanicolaou smear findings in solid-organ transplant recipients compared with normal subjects according to the Bethesda 2001 system.
abstract: OBJECTIVE
  Solid-organ transplant recipients are at increased risk of developing cancer including cervical cancer compared with woman in the general population, mostly due to long-term immunosuppressive therapy. The Papanicolaou smear remains the primary method of screening cervical pathology including preinvasive and invasive lesions. The objective of this study was to evaluate Pap smear findings in solid-organ transplant recipients, determine the prevalence of abnormal smears, and compare these patients with the general population.
  
  
  METHODS
  We retrospectively examined 111 women patients who received liver or kidney transplant between January 1990 to December 2012 at Başkent University Ankara Hospital. Pap smear findings were compared with normal control patients matched for same age and technical procedure of cervical cytology. To selection of control patients, propensity score matching program was performed. All Pap smears were re-examined according to Bethesda 2001 criteria.
  
  
  RESULTS
  In 111 transplant patients, 2 patients (1.8%) had atypical squamous cells of undetermined significance, 8 patients (7.2%) had low-grade squamous intraepithelial lesion, 15 patients (13.5%) had Candida infection, 2 patients (1.8%) had Trichomonas vaginalis, 1 patient (0.9%) had herpes simplex infection, 13 patients (11.7%) had bacterial vaginosis, 15 patients (13.5%) had reactive changes due to inflammation, and 18 patients (16.2%) had atrophy. When we compared our results with the control group, there were statistically significant differences (P ≤ .05) between the 2 groups in epithelial cell abnormalities (low-grade squamous intraepithelial lesion), Candida infection, bacterial vaginosis, and atrophy.
  
  
  CONCLUSIONS
  Pap smear screening potentially may help recognize cervical preinvasive and invasive lesions. The risk of developing cervical intraepithelial neoplasia is greater in transplant recipients because of immunosuppressive therapy. The incidence of low-grade squamous intraepithelial lesion was significantly greater in transplant recipients than the general population. Intensive follow-up with Pap smear in transplant recipients is important in the early detection of these lesions.
authors.affiliation: From the Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Alev
authors.initials: A
authors.lastname: Ok Atılgan
authors.forename: Merih
authors.initials: M
authors.lastname: Tepeoğlu
authors.forename: A Nihan
authors.initials: AN
authors.lastname: Haberal
authors.forename: Elif
authors.initials: E
authors.lastname: Durukan
authors.forename: Esra
authors.initials: E
authors.lastname: Kuşcu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D065309:Atypical Squamous Cells of the Cervix / Q000276:immunology / Q000473:pathology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D015995:Prevalence; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000276:immunology / Q000473:pathology*; D014626:Vaginal Smears; D014627:Vaginitis / Q000453:epidemiology / Q000276:immunology / Q000473:pathology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000276:immunology / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents