Anal cytological abnormalities and human papilloma virus in kidney transplant recipients

Abstract

Background: Transplant recipients have significantly elevated risk of anal cancer, compared to the general population. We sought to determine the presence of high risk human papilloma virus (hrHPV) and anal cytological abnormalities in kidney transplant recipients, and assess the feasibility of an anal cancer screening intervention. Methods: Kidney transplant recipients, over 18 years old, attending a Transplant Clinic, had anal swab specimens collected. These were then eluted into liquid-based cytology collection vials for cytological examination and HPV genotyping by Linear Array. Results: Of 102 participants approached, 73 (72%) consented to join the study and completed testing. The mean age was 47 (range 20–76 years). 64 (88%) had technically satisfactory cellularity. Of these, 8 (12.5%) were abnormal; 6 (9.4%) LSIL; 2 (3.1%) HSIL and 56 negative. 70 (96%) specimens were assessable for genotyping and 15 (21%) had HPV detected. 63 had both HPV and cytology assessable. Of the 15 with HPV, 4 (27%) had abnormal cytology, compared to 4 (7%) of 48 with no HPV. However, there was no evidence of an association between any HPV detection (low or high risk) and abnormal anal cytology (OR 2.75, 95% CI 0.82–11.84); p=0.12). Both participants with cytological HSIL had histological HSIL on HRA, both with multiple hrHPV. Conclusions: Transplant recipients were generally willing to consent to the study procedures, including anal swabbing. The prevalence of abnormal cytology was 12.5% and high risk HPV genotypes 12.3%. Anal swabbing was able to identify individuals at increased risk of anal cancer for future close monitoring.