Falsely elevated human epididymis protein 4 results and Risk of Ovarian Malignancy Algorithm in polymorbid women after solid organ transplantation: A pilot and case‐control study

Background Cancer prevention is essential after transplantation (Tx). The use of HE 4 and Risk of Ovarian Malignancy Algorithm ( ROMA ) is recommended as a tool for selective ovarian cancer screening; however, creatinine is a known confounder. This study assessed the reliability of HE 4, CA 125, and ROMA after Tx. Methods We matched a total of 202 women without gynecological malignancies and 236 men by age and serum creatinine. Each pair consisted of a patient after Tx (kidney, liver, heart, and pancreas) and a diseased but non‐Tx consecutive patient. Serum HE 4, CA 125 (Roche Cobas 6000), and creatinine (enzymatic, Abbott Architect) were measured in all patients. Results Creatinine correlated with HE 4 (women: r  = .864, P  < .0001; men: r  = .848, P  < .0001). Age correlated slightly with HE 4 in women ( r  = .250, P  < .005) and men ( r  = .240, P  < .0005). HE 4 in women after Tx (median of 84.8 pmol/L) was significantly higher than non‐Tx women (53.7 pmol/L, P  < .0001) in the reference range of serum creatinine. Neither HE 4 nor CA 125 correlated with tacrolimus concentration, but anemia, hyperparathyroidism, kidney, liver, and lung diseases were possible confounders for HE 4 after transplantation ( P  < .05). Conclusion Human epididymis protein 4 (HE4) was significantly increased in women after solid organ transplantation compared to levels without transplants matched by age and serum creatinine. HE 4 results may be misleading in these patients.