Cervical Cytology and Histology After Solid Organ Transplant: A Longitudinal Cohort Study

The ideal frequency of cervical cancer screening in women with solid organ transplants (SOTs) remains to be determined. We aimed to assess the longitudinal rates of cytologic and histologic cervical abnormalities in women after SOT.

We retrospectively reviewed health records of women aged 18 to 60 years who received their first kidney, liver, pancreas, or combination transplant at Mayo Clinic (Rochester, Minnesota) from 1995 through 2011. Patient demographics, cervical cytology and histology, and high-risk human papillomavirus (hrHPV) testing data were abstracted. All women included in the study had documentation of at least 1 cervical cytologic assessment after SOT. Cumulative incidence of abnormal cytology or histology was estimated using the Kaplan-Meier method.

In total, 459 women (mean age at SOT, 43.9 years) were included in the study. Pre-SOT cytology was benign in 226 (97.4%) of 232 patients with available results. During follow-up, 9 women had cervical intraepithelial neoplasia grade 3 or higher (CIN3) histology. The cumulative incidence of CIN3 was 0.2% (95% confidence interval [CI], 0%-0.6%) at 1 year after SOT, 0.7% (95% CI, 0%-1.5%) at 2 years, 1.9% (95% CI, 0.5%-3.3%) at 5 years, and 3.1% (95% CI, 0.4%-5.7%) at 10 years. At the time of the first post-SOT cervical cytology, a greater proportion of women who were hrHPV positive had abnormal findings compared with hrHPV-negative women (10/15 [66.7%] vs 1/71 [1.4%]; p < .001).

The cumulative incidence of CIN3 in the first 5 years after SOT approximates the level of risk for which annual cytologic assessment has been recommended.