Premium
Burden of anal squamous cell carcinoma, squamous intraepithelial lesions and HPV16 infection in solid organ transplant recipients: A systematic review and meta‐analysis
Author(s) -
Albuquerque Andreia,
Stirrup Oliver,
Nathan Mayura,
Clifford Gary M.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15942
Subject(s) - medicine , anal cancer , incidence (geometry) , population , immunosuppression , confidence interval , surgery , cancer , physics , environmental health , optics
The number of solid organ transplant recipients (SOTR), and their life expectancy, is increasing, with higher risk for long‐term complications from immunosuppression. We carried out a systematic review describing the burden of anal squamous cell carcinoma (SCC), and its surrogates, in SOTR. We conducted mixed effect model‐based meta‐analyses evaluating incidence of anal SCC (standardized incidence ratio [SIR] vs general population, and absolute incidence rate [IR]), prevalence of anal squamous abnormalities, and human papillomavirus (HPV) 16. Generalized I 2 statistics were calculated, quantifying heterogeneity. Anal SCC incidence in SOTR was elevated vs the general population (pooled SIR = 6.8, 95% confidence interval [CI], 4.3‐10.9; 6 studies including 241 106 SOTR; I 2 = 82.3%), with an absolute IR of 12.3 (95% CI, 10.4‐14.7) per 100 000 person‐years (5 studies including 1 079 489 person‐years; I 2 = 0%). Prevalence of abnormal anal cytology was 12.9% (95% CI, 9.2%‐17.7%; 6 studies including 328 SOTR; I 2 = 17.4%). For histology, the pooled prevalence estimate of anal squamous intraepithelial lesions was 22.4% (95% CI, 17.3%‐28.5%; 3 studies including 214 SOTR; I 2 = 0%), with 4.7% (95% CI, 2.5%‐8.5%; I 2 = 0%) high‐grade squamous intraepithelial lesions. Pooled anal HPV16 prevalence was 3.6% (95% CI, 1.6%‐7.8%; 4 studies including 254 SOTR; I 2 = 17.6%). There was substantial and consistent evidence of elevated anal SCC incidence in SOTR.