Cervical Screening and HPV Vaccination in Kidney Transplant Recipients

Background: Human papillomavirus (HPV)-associated cancers, such as cervical cancer, are more prevalent in kidney transplant recipients (KTR). Historical data, prior to an established national screening programme, suggest cervical screening uptake in KTRs is low. Little is known about HPV vaccination uptake in KTRs in Ireland. This study aimed to investigate cervical screening and HPV vaccination uptake in KTRs, while identifying patient-level barriers to the same. Methods: A retrospective cohort study was conducted in two groups in a single centre: firstly, all female KTRs ≤65 years regarding cervical screening, and secondly, all KTRs ≤45 years regarding HPV vaccination status. Telephone questionnaires were administered to patients who consented. Results: Regarding cervical screening, 42 of 217 eligible female KTRs ≤65 years consented to participate, with three then excluded due to prior hysterectomy. The mean age was 45.3 years (SD: 10) and the mean transplant vintage was 123.6 months (SD: 86.2). Thirty-four patients (87%) had undergone screening since transplantation, and all of those reported adherence with annual screening. Of the five patients (13%) who had not had screening, two indicated this was due to no communication from the screening programme. Awareness of a specific recommendation for annual cervical screening in KTRs was present in 27 patients (69%). Abnormal cervical screening had occurred in 18 patients (46%). Regarding HPV vaccination, 23 of 48 eligible KTRs who were ≤45 years consented to participate. The mean age of this cohort was 37 years (SD: 6.1) and the mean transplant vintage was 86.3 months (SD: 60.4). Five patients (22%) were HPV vaccinated. There was awareness that KTRs have an increased cancer risk in 20 patients (87%), but only 9% and 4% were aware that HPV vaccination could reduce cancer risk and is Health Service Executive (HSE) guideline recommended, respectively. For unvaccinated KTRs (n=18), all patients stated that they would accept HPV vaccination if provided at their hospital without charge. Conclusion: Engagement with cervical screening in this cohort of KTRs was high. A risk of self-selection bias exists and a larger, nationwide study is warranted. Low awareness exists on the recommendation and importance of HPV vaccination for KTRs. Unvaccinated patients were highly willing to receive HPV vaccination if administered at their transplant centre.