Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Transpl Infect Dis. 2024 Aug;26(4):e14286. doi: 10.1111/tid.14286. Epub 2024 May 2.
Solid organ transplant recipients are at an increased risk for anogenital Human Papillomavirus (HPV)-related disease, including anal high-grade squamous intraepithelial lesions (HSIL) and anal squamous cell cancer (ASCC). Guidelines for ASCC screening in transplant recipients are limited. Our aim was to understand current practice of ASCC screening in adult liver transplant (LT) candidates and recipients at transplant centers across the United States.
We surveyed medical directors of 113 LT centers across the United States which had publicly available contact information. The survey evaluated center perceptions on cancer and HPV disease risk in transplant populations, ASCC screening, barriers and facilitators for ASCC screening and HPV vaccination practices.
We received 26/113 (23%) responses, of which 24 were complete and included in the analysis. Eleven of 24 (46%) centers reported screening for ASCC and 3/24 (12.5%) centers reported having formal guidelines. Centers who perform ASCC screening were more likely to perform transplants in people living with HIV and were more aware of the burden of HPV disease in transplant populations. All respondents believed that additional data on the impact of screening on ASCC incidence would support screening decisions. Increased access to specialists for screening/high-resolution anoscopy was also perceived as a facilitator. Only 7/24 (29%) centers regularly evaluated HPV vaccination status of their patients.
This national survey of LT centers reveals non-standardized ASCC screening practices, and identified data, educational and resource needs to improve prevention of ASCC in this population.
实体器官移植受者发生肛门生殖器人乳头瘤病毒（HPV）相关疾病（包括肛门高级别鳞状上皮内病变[HSIL]和肛门鳞状细胞癌[ASCC]）的风险增加。针对移植受者 ASCC 筛查的指南有限。我们的目的是了解美国各移植中心的成人肝移植（LT）候选者和受者中 ASCC 筛查的当前实践情况。
我们调查了美国 113 家 LT 中心的医学主任，这些中心都有公开的联系方式。该调查评估了中心对移植人群中癌症和 HPV 疾病风险、ASCC 筛查、ASCC 筛查的障碍和促进因素以及 HPV 疫苗接种实践的看法。
我们收到了 113 个中心中的 26 个（23%）回复，其中 24 个完整回复并纳入分析。24 个中心中有 11 个（46%）报告了 ASCC 筛查，其中 3 个（12.5%）中心报告了正式的筛查指南。进行 ASCC 筛查的中心更有可能为 HIV 感染者进行移植，并且更了解 HPV 疾病在移植人群中的负担。所有受访者都认为，更多关于筛查对 ASCC 发生率影响的数据将支持筛查决策。增加对筛查/高分辨率肛门镜检查的专家的访问也被认为是一个促进因素。只有 24 个中心中的 7 个（29%）定期评估其患者的 HPV 疫苗接种状况。
这项针对 LT 中心的全国性调查揭示了非标准化的 ASCC 筛查实践，并确定了数据、教育和资源需求，以改善该人群中 ASCC 的预防。
