Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development. METHODS: This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia. RESULTS: Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29-53). Forty-seven (11.9%; 95% CI 8.8-15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6-12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33-6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96-18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years. CONCLUSIONS: One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.

Original languageEnglish (US)
Pages (from-to)385-394
Number of pages10
JournalObstetrics and gynecology
Volume134
Issue number2
DOIs
StatePublished - Aug 1 2019

Fingerprint

Hydroxychloroquine
Cervical Intraepithelial Neoplasia
Organ Transplantation
Odds Ratio
Uterine Cervical Dysplasia
Carcinoma
Transplants
Electronic Health Records
Incidence
Tertiary Care Centers
Cervix Uteri
Retrospective Studies
Logistic Models
Demography
Population
Neoplasms
Transplant Recipients
TimeLine

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients. / Thimm, Matthew A.; Rositch, Anne F.; VandenBussche, Christopher; McDonald, Lynn; Garonzik Wang, Jacqueline M.; Levinson, Kimberly.

In: Obstetrics and gynecology, Vol. 134, No. 2, 01.08.2019, p. 385-394.

Research output: Contribution to journalArticle

@article{07da4942e1064b548e2f7312d8294940,
title = "Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients",
abstract = "OBJECTIVE: To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development. METHODS: This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia. RESULTS: Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29-53). Forty-seven (11.9{\%}; 95{\%} CI 8.8-15.9{\%}) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6-12.9). Thirty-eight (9.6{\%}) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6{\%}) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8{\%}) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3{\%}) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5{\%}) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95{\%} CI 1.33-6.13) as was hydroxychloroquine use (OR 5.95; 95{\%} CI 1.96-18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years. CONCLUSIONS: One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.",
author = "Thimm, {Matthew A.} and Rositch, {Anne F.} and Christopher VandenBussche and Lynn McDonald and {Garonzik Wang}, {Jacqueline M.} and Kimberly Levinson",
year = "2019",
month = "8",
day = "1",
doi = "10.1097/AOG.0000000000003378",
language = "English (US)",
volume = "134",
pages = "385--394",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients

AU - Thimm, Matthew A.

AU - Rositch, Anne F.

AU - VandenBussche, Christopher

AU - McDonald, Lynn

AU - Garonzik Wang, Jacqueline M.

AU - Levinson, Kimberly

PY - 2019/8/1

Y1 - 2019/8/1

N2 - OBJECTIVE: To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development. METHODS: This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia. RESULTS: Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29-53). Forty-seven (11.9%; 95% CI 8.8-15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6-12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33-6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96-18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years. CONCLUSIONS: One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.

AB - OBJECTIVE: To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development. METHODS: This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia. RESULTS: Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29-53). Forty-seven (11.9%; 95% CI 8.8-15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6-12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33-6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96-18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years. CONCLUSIONS: One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.

UR - http://www.scopus.com/inward/record.url?scp=85070660729&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070660729&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000003378

DO - 10.1097/AOG.0000000000003378

M3 - Article

C2 - 31306332

AN - SCOPUS:85070660729

VL - 134

SP - 385

EP - 394

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 2

ER -