Cervical Human Papillomavirus in transplanted Italian women: a long-term prospective follow-up study.

ABSTRACT

BACKGROUND: Human Papillomavirus (HPV) is the leading cause of cervical cancer among women. Immunosuppression is recognized as one of the major risk factors for HPV infection and persistence. OBJECTIVES: Aim of this study was to determine if solid organs (24 kidney and 24 kidney/pancreas) transplanted Italian women undergoing immunosuppressive therapies were at higher risk of HPV genital infection and cervical precancerous lesions in a ten-year follow-up. STUDY DESIGN: Forty-eight women that underwent transplant from 1990 to 2000, receiving multi-drug immunosuppressive therapy, were enrolled prospectively in a long-term follow-up protocol. Patients were cytologically (Pap smear) and virologically (HPV-DNA test) tested each year for 10 years. Incidence of HPV-DNA positivity and of cervical cytological/histological abnormalities was collected. Results were statistically analyzed and compared to a matching control group of 200 healthy women. RESULTS: HPV-DNA positivity and cytological High-Grade (HG-SIL) cervical lesions did not show statistically significant differences in cases compared to controls, while statistical significance was observed in Low-Grade (LG-SIL) cytological diagnoses. No statistically significant difference was observed in histology-proven cervical lesions. CONCLUSIONS: Women receiving immunosuppression therapy following transplant do not seem to require intensive follow-up, and should not be considered a high-risk subgroup, as they do not show a statistically significant higher incidence of HPV infections or high-grade cervical dysplasia compared to healthy immunocompetent matching controls.