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Open Access Research

Prevalence of high-risk human papillomavirus cervical infection in female kidney graft recipients: an observational study

Bronislawa Pietrzak1*, Natalia Mazanowska1, Alicja M Ekiel2, Magdalena Durlik3, Gayane Martirosian24, Mirosław Wielgos1 and Pawel Kaminski1

Author Affiliations

1 First Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl. Starynkiewicza 1/3, 02-015, Warszawa, Poland

2 Department of Medical Microbiology, Medical University of Silesia, ul. Medykow 18, 40-752, Katowice, Poland

3 Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, ul. Lindleya 4, 02-015, Warszawa, Poland

4 Department of Histology and Embryology, Medical University of Warsaw, ul. Chalubinskiego 4, 02-004, Warszawa, Poland

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Virology Journal 2012, 9:117  doi:10.1186/1743-422X-9-117

Published: 18 June 2012

Abstract

Background

Immunosuppressive therapy protects the transplanted organ but predisposes the recipient to chronic infections and malignancies. Transplant patients are at risk of cervical intraepithelial neoplasia (CIN) and cervical cancer resulting from an impaired immune response in the case of primary infection or of reactivation of a latent infection with human papillomavirus of high oncogenic potential (HR-HPV).

Methods

The aim of this study was to assess the prevalence of HR-HPV cervical infections and CIN in 60 female kidney graft recipients of reproductive age in comparison to that in healthy controls. Cervical swabs were analyzed for the presence of HR-HPV DNA. HR-HPV-positive women remained under strict observation and were re-examined after 24 months for the presence of transforming HR-HPV infection by testing for HR-HPV E6/E7 mRNA. All the HR-HPV-positive patients were scheduled for further diagnostic tests including exfoliative cytology, colposcopy and cervical biopsy.

Results

The prevalence of HR-HPV did not differ significantly between the study group and the healthy controls (18% vs 25%, p = 0.37). There was no correlation between HR-HPV presence and the immunosuppresive regimen, underlying disease, graft function or time interval from transplantation. A higher prevalence of HR-HPV was observed in females who had had ≥2 sexual partners in the past. Among HR-HPV-positive patients, two cases of CIN2+ were diagnosed in each group. In the course of follow-up, transforming HR-HPV infections were detected in two kidney recipients and in one healthy female. Histologic examination confirmed another two cases of CIN2+ developing in the cervical canal.

Conclusions

Female kidney graft recipients of reproductive age are as exposed to HR-HPV infection as are healthy individuals. Tests detecting the presence of HR-HPV E6/E7 mRNA offer a novel diagnostic opportunity in those patients, especially in those cases where lesions have developed in the cervical canal.

Keywords:
Renal transplantation; HPV mRNA; HR-HPV; Immunosuppressive therapy; Cervical intraepithelial neoplasia