BM ROSALES1, J LANGTON LOCKTON2, J ROBERTS3, SN TABRIZI4, A GRULICH5, RJ HILLMAN6, A WEBSTER1,2
1University of Sydney, Sydney, New South Wales; 2Westmead Hospital, Sydney, New South Wales; 3Douglas Hanly Moir Pathology, Sydney, New South Wales; 4Royal Children’s Hospital, Melbourne, Victoria; 5The Kirby Institute, Sydney, New South Wales
Aim: To determine the presence of human papilloma virus (HPV) associated anal cytological changes in kidney transplant recipients, and assess the feasibility of a cancer screening program.
Background: Transplant recipients have increased anal cancer rates, 12 times higher than the general population in Australia and New Zealand. High risk HPV genotypes cause 80-90% of anal cancers.
Methods: Renal transplant recipients were recruited from December 2014.After completing a demographic and behavioural questionnaire, anal liquid-based Papanicolaou (Pap) tests were obtained and tested for cytological changes and the presence of HPV genotypes.
Results: Of 81 eligible participants approached, 56 (69%) consented to join the study. Mean age was 49 (median=47, range 20-76 years). Of 44 cytological samples with satisfactory results, 6 (13.6%) were consistent with Low grade anal Squamous Intraepithelial Lesions (LSIL), 2 (4.5%) High grade anal Squamous Intraepithelial Lesions (HSIL) and 36 were negative. Of 49 specimens HPV genotyped, 44 (93%) were assessable. HPV was detected in 6 (13.6%) participants, including two high risk genotypes (35 & 59). The proportion of HPV positive participants that also had abnormal cytology was twice that of those with no HPV; 2 (33%) of 6 HPV positive participants had abnormal cytology, compared to 5 (14.3%) of 35 participants with no HPV. However, there was no evidence of an association between HPV infection detected and abnormal anal cytology (OR = 0.8; 95%CI 0.16-3.72; P>0.9).
Conclusions: Transplant recipients were generally willing to undergo anal swabbing. The rate of anal cytological abnormalities was substantially higher than that typically found in cervical screening programs. Testing for HPV could identify further individuals at risk of anal cancer.