title: Clinical outcomes of abnormal cervical cytology and human papillomavirus-related lesions in patients with organ transplantation: 11-year experience at a single institution.
abstract: OBJECTIVE
  The objective of this study is to analyze the clinical outcomes of abnormal cervical cytology and newly diagnosed human papillomavirus (HPV)-related disease after organ transplantation.
  
  
  METHODS
  Medical records from July 2004 to August 2015 were reviewed, and thirteen patients were identified who had been newly diagnosed with HPV-related disease (cervical intraepithelial neoplasia [CIN] and cervical cancer) after organ transplantation. The median transition time to the aggravation of cervical cytology and the spontaneous regression rate of CIN were evaluated. Clinical outcomes of CIN1 and CIN2 were compared between the general population and patients with organ transplantation. We also reviewed the current literature regarding the incidence of HPV infection, Pap smear abnormality and/or CIN after organ transplantation.
  
  
  RESULTS
  The cervical cytology aggravated in nine of the 13 patients (69 %). In seven of the 13 cases (54 %), treatments such as cervical conization, laser vaporization, or radiation therapy, were conducted. HPV-related disease disappeared after treatment in only three of the seven actively treated cases (43 %). In contrast, the lesions persisted in three (43 %) cases after treatment. One patient died from cervical cancer. The spontaneous regression rate of the HPV-related diseases, if left untreated, was 0 %. There was a statistically significant difference in the clinical outcomes of CIN1 and CIN2 between the general population and patients with organ transplantation (p = 0.0026 and 0.0315, respectively; chi-squared test).
  
  
  CONCLUSIONS
  HPV-related lesions that are newly diagnosed after organ transplantation do not seem to regress as spontaneously as in the general population. Physicians should recognize the importance of close monitoring and long-term follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. zvf03563@nifty.ne.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kakuda
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kubota
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Matsuzaki
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Egawa-Takata
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuzaki
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D066027:Transplant Recipients; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology*
keywords: CIN; Cancer screening; Cervical cytology; HPV; Immunosuppression; Organ transplantation