Sex and organ-specific risk and temporal trends of human papillomavirus-associated anogenital cancer among solid organ transplant recipients in the United States

Solid organ transplant recipients (SOTRs) have an elevated risk of persistent infection of human papillomavirus (HPV) and associated anogenital (cervical, vulva, and vaginal among women, penile among men and anal among both men and women) cancers. Risk stratification and temporal trends of cancer incidence will help early detection, evaluation, management, and treatment of post-transplant cancers over time. We analyzed data of 239,613 heart, lung, liver, and kidney transplant recipients registered from 1987 to 2020 in the U.S. Scientific Registry of Transplant Recipients (SRTR) with cancer diagnosis reported during follow-up. There were 693 new cases of HPV-associated anogenital cancers, including 176 anal, 118 cervical, 310 vulvar, and 89 penile cancers. The age-adjusted incidence rates and confidence intervals (IRs [95% CI] per 100,000 person-years) were anal (10.5 [9.1, 12.2]), cervical (17 [14.2, 20.4]), vulvar (44.2 [39.5, 49.4]), and penile (9.0 [7.3, 11.1]). Overall, the risk of all cancers among SOTRs remains elevated compared with the U.S. general population: standardized incidence ratio (SIR) for anal (2.73 [2.34, 3.14]), cervical (1.46 [1.21, 1.73]), vulvar (8.82 [7.87, 9.83]), and penile (6.13 [3.38, 9.70]). Lung recipients showed the highest IR for anal, vulvar, and penile cancer, while heart recipients demonstrated the highest IR for cervical cancer. Similarly, the 10-year cumulative incidence (per 100,000 persons) of anal (124), vulvar (523) and penile (95) cancer was highest among lung recipients, while the highest cumulative incidence of cervical cancer (231) was among heart recipients. These data can help develop risk stratification for HPV-associated cancer screening and management among SOTRs.