Rosales Brenda Maria, Langton-Lockton Julian, Cornall Alyssa M, Roberts Jennifer M, Hillman Richard J, Webster Angela Claire
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Biala Community Health Centre, Brisbane, Australia.
Transplant Direct. 2019 Mar 4;5(4):e434. doi: 10.1097/TXD.0000000000000873. eCollection 2019 Apr.
Kidney recipients have anal cancer rates 3 times higher than the general population in Australia and New Zealand. High-risk human papillomavirus (HPV) genotypes are implicated in the majority of anal cancers. Establishing the epidemiology of anal HPV infection and precursors of anal cancer in transplant recipient populations is 1 consideration in any potential screening program. The Transplant and Anal Neoplasia Study is a cross-sectional study of the prevalence of anal cytological abnormalities and HPV deoxyribonucleic acid in kidney transplant recipients, as well as evaluating the acceptability of an anal cancer screening intervention. The study aims to recruit 100 kidney transplant recipients, older than 18 years, in Australia. Transplant recipients attending for a protocol biopsy at 3 and 12 months and annually posttransplant are approached to participate. Participants undergo an anal swab, which is then analyzed using liquid-based cytological examination and tested for the detection of 37 anogenital HPV deoxyribonucleic acid genotypes. Participants also complete a demographic and behavioral questionnaire that covers sexual behavior, history of anal symptoms, and possible anal cancer risk factors. Associations will be tested using multiple regression analysis. Recruitment for the study began in 2015 and is ongoing. To date, 96 (77%) of 125 kidney transplant recipients approached have consented to the study. The mean age is 48 (median, 47 y; range, 20-76 y), 59% are male, and Northwest European (58%) represented the largest ethnic group. No participants self-identified as Aboriginal or Torres Strait Islander. High consent rates and positive qualitative results suggest that a larger screening program may be well received by kidney transplant recipients, with increased resources and some modification to the timing of approach. Further results of the study will inform the possible implementation of a larger screening trial for prevention of anal cancers in kidney and other solid organ transplant recipients.
在澳大利亚和新西兰，肾移植受者患肛门癌的几率是普通人群的3倍。高危型人乳头瘤病毒（HPV）基因型与大多数肛门癌有关。在任何潜在的筛查项目中，确定移植受者群体中肛门HPV感染的流行病学情况以及肛门癌的癌前病变是一个需要考虑的因素。移植与肛门肿瘤研究是一项横断面研究，旨在调查肾移植受者肛门细胞学异常和HPV脱氧核糖核酸的患病率，并评估肛门癌筛查干预措施的可接受性。该研究的目标是在澳大利亚招募100名年龄超过18岁的肾移植受者。邀请在术后3个月、12个月以及每年进行方案活检的移植受者参与研究。参与者需接受肛门拭子检查，然后使用液基细胞学检查进行分析，并检测37种肛门生殖器HPV脱氧核糖核酸基因型。参与者还需完成一份人口统计学和行为调查问卷，内容涵盖性行为、肛门症状史以及可能的肛门癌风险因素。将使用多元回归分析来检验各种关联。该研究于2015年开始招募参与者，目前仍在进行中。迄今为止，在125名被邀请的肾移植受者中，有96名（77%）同意参与研究。参与者的平均年龄为48岁（中位数为47岁；范围为20 - 76岁），59%为男性，西北欧裔（58%）是最大的种族群体。没有参与者自认为是原住民或托雷斯海峡岛民。高同意率和积极的定性结果表明，扩大筛查项目可能会受到肾移植受者的欢迎，但需要增加资源并对邀请时间进行一些调整。该研究的进一步结果将为是否可能开展一项更大规模的筛查试验以预防肾移植及其他实体器官移植受者的肛门癌提供依据。
