Böbrek Nakli Yapılmış Hastalarda Servikal Sitoloji Bulguları ve Bu Bulguların Normal Bireylerle Karşılaştırılması

Öz

Uzun süreli immünsüpresif tedavi, böbrek nakli yapılan hastalarda servikal kanser gelişme olasılığını artırır. Bu çalışmada, böbrek nakli yapılan hastalarda servikal sitoloji sonuçlarını incelemeyi, bu bulguları normal popülasyonla karşılaştırmayı ve skuamöz intraepitelyal lezyon gelişimiyle ilişkili risk faktörlerini belirlemeyi amaçladık. Ocak 2000 ile Nisan 2018 tarihleri arasında, 140 kadın böbrek nakli alıcısının tıbbi kayıtlarını retrospektif olarak analiz edildi. Yaş ve servikal sitoloji prosedürü temel alınarak, normal sağlık durumuna sahip 280 kadından oluşan bir kontrol grubu seçildi ve eşleştirildi. Hastaların Pap smear bulguları, Bethesda 2014 kriterlerine göre yeniden değerlendirildi. Toplam 420 hastanın 37'sinde epitel hücre anormallikleri saptandı; bunların 32'si (%86,5) böbrek nakli grubunda ve 5'i (%13,5) kontrol grubundaydı (p ≤ 0,001). Enfeksiyonların görüldüğü 62 hasta vardı; bunların 44'ü (%71) böbrek nakli grubunda ve 18'i (%29) kontrol grubundaydı (p ≤ 0,001). Squamous intraepitelyal lezyon gelişiminin, hastanın primer böbrek hastalığının immünolojik bir hastalık olması, yeniden nakil olma ve akut rejeksiyon varlığı gibi faktörlerle ilişkili olduğunu saptandı (p ≤ 0,05). Pap smear taraması, servikal preinvaziv lezyonların tespitinde önemli bir rol oynamaktadır. Epitel hücre anormalliklerinin görülme sıklığı, böbrek nakli alıcılarında normal popülasyona kıyasla belirgin şekilde daha yüksektir. Nakil alıcılarında servikal kanser ilerlemesinin erken tespiti ve önlenmesi için düzenli servikal sitoloji takibi hayati önem taşımaktadır.

Anahtar Kelimeler

• Servikal sitoloji
• İmmunsupresyon
• Pap smear
• Böbrek nakli

Cervical Cytology Findings in Renal Transplant Patients and Comparison of These Findings with Normal Population

Öz

Long-term immunosuppressive therapy increases the likelihood of renal transplant patients developing cervical cancer. We aimed to analyze the results of cervical cytology in renal transplant patients, compare these findings to those of the normal population, and determine the risk factors linked to the development of squamous intraepithelial lesions. Our analysis involved a retrospective study of hospital records from January 2000 to April 2018, encompassing 140 female renal transplant patients. A control group of 280 women with normal health status was selected and matched based on age and the cervical cytology procedure. The cervical cytology findings of the patients were re-evaluated using the Bethesda 2014 criteria. Of the total of 420 patients, 37 patients had epithelial cell abnormalities; including 32 (86.5%) patients in the renal transplant group and 5 (13.5%) control group (p ≤ 0.001). Sixty-two patients had infections; including 44 (71%) patients in the renal transplant group and 18 (29%) control group (p ≤ 0.001). We revealed that the development of squamous intraepithelial lesions was associated with factors such as having an immunologic disease as the primary renal disease, undergoing re-transplantation, and the presence of acute rejection (p ≤ 0.05). Cervical cytology screening plays a crucial role in detecting preinvasive lesions. The incidence of epithelial cell abnormalities is significantly higher in renal transplant patients compared to the normal population. Regular cervical cytology follow-up is vital for the early detection and prevention of cervical cancer progression in transplant recipients.

Anahtar Kelimeler

• Cervical cytology
• Immunosuppression
• Pap smear
• Renal transplantation

Kaynakça

1. 1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.
2. 2. Park ST, Song MJ, Park JS, et al. Incidence and clinicopathologic behavior of uterine cervical carcinoma in renal transplant recipients. World J Surg Oncol. 2011;9:72.
3. 3. Courtney AE, Leonard N, O'Neill CJ, et al. The uptake of cervical cancer screening by renal transplant recipients. Nephrol Dial Transplant. 2009;24(2):647-52.
4. 4. Wilbur DC, Nayar R. Bethesda 2014: improving on a paradigm shift. Cytopathology. 2015;26(6):339-42.
5. 5. Madeleine MM, Finch JL, Lynch CF, et al. HPV-related cancers after solid organ transplantation in the United States. Am J Transplant. 2013;13(12):3202-9.
6. 6. Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-46.
7. 7. Paternoster DM, Cester M, Resente C, et al. Human papilloma virus infection and cervical intraepithelial neoplasia in transplanted patients. Transplant Proc. 2008;40(6):1877-80.
8. 8. Origoni M, Stefani C, Dell'Antonio G, et al. Cervical human papillomavirus in transplanted Italian women: a long-term prospective follow-up study. J Clin Virol. 2011; 51(4):250-4.

9. 9. Marschalek J, Helmy S, Schmidt A, et al. Prevalence of genital dysplasia after kidney transplantation--a retrospective, non-interventional study from two centers. Acta Obstet Gynecol Scand. 2015;94(8):891-7.
10. 10. Bilgi A, Gökulu ŞG, İlgen O, et al. Cervical dysplasia after renal transplantation: A retrospective cohort study. Turk J Obstet Gynecol. 2021;18(1), 7–14.
11. 11. Murray SL, Daly FE, O'Kelly P, et al. The impact of switching to mTOR inhibitor-based immunosuppression on long-term non-melanoma skin cancer incidence and renal function in kidney and liver transplant recipients. Ren Fail. 2020;42(1):607-12.
12. 12. Smith A, Niu W, Desai A. The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients. Cureus. 2017;9(8):e1564.
13. 13. Chin-Hong PV. Human Papillomavirus in Kidney Transplant Recipients. Semin Nephrol. 2016;36(5):397-404.
14. 14. Schlecht NF, Platt RW, Duarte-Franco E, et al. Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J Natl Cancer Inst. 2003;95(17): 1336-43.
15. 15. Moscicki AB, Shiboski S, Hills NK, et al. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. 2004; 364(9446):1678-83.
16. 16. Ok Atılgan A, Tepeoğlu M, Haberal AN, et al. Papanicolaou smear findings in solid-organ transplant recipients compared with normal subjects according to the Bethesda 2001 system. Exp Clin Transplant. 2015;13 Suppl 1:219-22.