Nailescu Corina, Shew Marcia L
Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, IN, United States.
Front Pediatr. 2022 Nov 30;10:1057454. doi: 10.3389/fped.2022.1057454. eCollection 2022.
Malignancies are found between the first three reasons of mortality in pediatric and adult kidney transplant recipients, who overall have disproportionately higher rates of cancer compared to the general population, including human papillomavirus (HPV)-related genital, anal and oropharynx region cancers. Therefore, preventing HPV in this patient population is extremely important. HPV-vaccine was demonstrated to prevent HPV infection in individuals with intact immune systems. In addition, recent data reported less precancerous HPV lesions and cervical cancers with use of HPV vaccine. Since HPV is a sexually transmitted virus that is typically acquired shortly after the onset of sexual activity, it is best to administer the HPV vaccine immunization prior to the onset of sexual activity. This article reviews the epidemiology and pathophysiology of the HPV infection, as well as its role in the development of HPV-related pre-cancerous lesions and cancers in both general population and kidney transplant recipients. The focus is on the most effective primary prophylactic strategy, which is the HPV vaccination. The particularities of HPV vaccination strategies in kidney transplant recipients are compared to the general population. In addition, the article analyzes the various causes of suboptimal HPV immunization rates in kidney transplant candidates and recipients and discusses vaccination optimization strategies that can be applied during childhood and adolescence to reduce the burden of HPV-related disease states and cancer among adult kidney transplant recipients.
恶性肿瘤是儿童和成人肾移植受者死亡的前三大原因之一,总体而言,他们患癌症的比例比普通人群高得多,包括与人乳头瘤病毒(HPV)相关的生殖器、肛门和口咽区域癌症。因此,在这一患者群体中预防HPV极为重要。HPV疫苗已被证明可预防免疫系统健全者感染HPV。此外,最近的数据报告显示,使用HPV疫苗后癌前HPV病变和宫颈癌的发生率有所降低。由于HPV是一种性传播病毒,通常在开始性行为后不久就会感染,因此最好在开始性行为之前接种HPV疫苗。本文综述了HPV感染的流行病学和病理生理学,以及其在普通人群和肾移植受者中HPV相关癌前病变和癌症发展中的作用。重点是最有效的一级预防策略,即HPV疫苗接种。将肾移植受者HPV疫苗接种策略的特殊性与普通人群进行了比较。此外,本文分析了肾移植候选者和受者HPV免疫接种率不理想的各种原因,并讨论了可在儿童期和青春期应用的疫苗接种优化策略,以减轻成年肾移植受者中HPV相关疾病状态和癌症的负担。