Risk of Cervical Dysplasia Rises in Women After Lung Transplant

Teresa Carvalho MSc avatar

by Teresa Carvalho MSc |

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Women with cystic fibrosis (CF) who underwent a lung transplant are at higher risk of cervical dysplasia, or abnormal (precancerous) cells on the lower part of the uterus (cervix), a study reports.

The risk increases among women who are not vaccinated against human papillomavirus (HPV), the main risk factor for cervical cancer. The researchers said it is important for CF specialists to advise their female patients to get vaccinated.

The study, “Human papillomavirus (HPV) and cervical dysplasia in adult female cystic fibrosis (CF) lung transplant recipients,” was published in Thorax.

Lung transplant is a surgical option for CF patients with advanced lung disease. To prevent the body rejecting the transplanted lungs, patients take immunosuppressive therapies that are known to weaken their immune system.

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Some studies have reported that people under immunosuppressive treatment post-transplant are at higher risk of HPV-related problems. “Given the predisposition towards lung transplantation and consequent immunosuppression in CF, understanding factors impacting the outcomes is of utmost importance,” the scientists wrote.

Researchers in Canada conducted a study at a single center to determine the prevalence of HPV-related complications in a group of women with CF who had transplants and those who did not.

Their study involved 34 patients who had transplants between 2008 and 2021, and 64 others who served as controls. Several gynecological records were analyzed, including Papanicolaou (pap) smears — a method that collects cells from the cervix for examination — colposcopy (a close-up look at the cervix) and surgical procedures, the presence of cervical cancer, cervical dysplasia, and refractory anogenital warts (small lumps that develop on the genitals or around the anus, caused by the HPV virus).

A total of 12 transplant patients (median age, 26.7 years) had at least one abnormal pap smear, with 11 (91.7%) following a transplant. Among these women, nine (75%) had cervical dysplasia, three (25%) had refractory anogenital warts, and two (17%) needed a vulvectomy (surgery that removes all or part of the vulva). Four of the women (33%) developed cervical cancer and two (17%) died of metastasis-related complications.

Cervical dysplasia was about four times more likely to occur in transplant patients than in controls, the researchers reported.

This study “highlights the prevalence and potentially devastating impact of HPV in CF after lung transplantation,” they said.

However, the researchers suggested that CF may be a confounding risk factor as chronic inflammation could result in increased thickening of cervical mucus, which may enhance susceptibility to HPV. “Larger cohorts [groups of patients] would need to be analyzed to develop meaningful conclusions around the type and intensity of immunosuppression and risk of HPV-related sequelae,” they wrote.

The study also compared the presence of HPV-related problems in women with CF vaccinated against the virus with those who were not vaccinated. None of the nine vaccinated women were found to have HPV-related issues while 12 of the 25 unvaccinated patients (48%) did.

There are currently no recommendations regarding HPV vaccination prior to a lung transplant, particularly in CF patients.

“Notably, none of the patients included in our study with HPV complications was vaccinated either prior to or following transplantation, identifying a gap in clinical care in this population that merits further exploration,” the investigators wrote.

The research team emphasized that clinicians need to initiate routine universal HPV vaccination of children and adults with CF given the high percentage of CF patients who undergo a lung transplant.

“To survive end-stage CF lung disease and lung transplantation only to experience life-altering morbidity (affecting sexual health, personal confidence, relationships, etc) and potential mortality of HPV — a highly vaccine-preventable disease — is now unacceptable,” they wrote.