Human papillomavirus (HPV) is a common sexually transmitted virus. Around 40 genotypes are known to have an affinity for the epithelium in the anogenital area. They can be divided into low-risk (lrHPV) and high-risk (hrHPV) HPV types based on the oncogenic potential, with HPV types 16 and 18 being the most carcinogenic types among hrHPV (Tjalma et al., 2005). Risk factors for an HPV infection are multiple sex partners, smoking, and immunosuppression (Schiffman et al., 2016; Tjalma et al., 2005; Nielsen et al., 2008). Immunocompetent individuals are most often able to clear the HPV infection within 1–2 years, however, in a small proportion of individuals, the infection becomes persistent, and this increases the risk of different cancers, such as cervical cancer (Winer et al., 2011; Schiffman et al., 2016). Cervical cancer ranks as the fourth most prevalent cancer among women in the world, and notably, cervical cancer is the leading cause of cancer-related deaths in 36 countries (Sung et al., 2021). In 2020, there were >600,000 new cases of cervical cancer diagnosed, resulting in nearly 342,000 deaths worldwide (Sung et al., 2021).

In 2021, 92,532 kidney transplantations were performed globally, constituting an increase of 14.3% compared to 2020 (Transplantation, G. O. O. D. A, 2024). Women living with a transplanted kidney are on immunosuppressive therapy to prevent graft rejection and to increase the survival rate. The lifelong treatment with immunosuppressive therapy contributes to improved long-term survival rates (Dugue et al., 2013). Nevertheless, it also increases the likelihood of developing certain cancers, such as cervical cancer (Au et al., 2018). It has been suggested that women with a transplanted kidney have an increased risk of HPV infection (Dugue et al., 2013). Some prior clinical studies have investigated the prevalence of cervical hrHPV infection (Aggarwal et al., 2014; Chen et al., 2022; Cistjakovs et al., 2018; Eleuterio Jr et al., 2019; Hinten et al., 2017; Masinde et al., 2022; Mazanowska et al., 2013; Meeuwis et al., 2015; Nordin et al., 2007; Parra-Avila et al., 2021; Ring et al., 2023; Roensbo et al., 2018; Seshadri et al., 2001; Sun et al., 2021; Veroux et al., 2009; Wielgos et al., 2020). However, these studies were limited by small sample sizes (range: 21–218). Additionally, only around half of these studies reported the prevalence of the most oncogenic HPV types (HPV16 and18), and only a minority included a control group (Chen et al., 2022; Cistjakovs et al., 2018; Mazanowska et al., 2013; Nordin et al., 2007; Ring et al., 2023; Seshadri et al., 2001).

The aim of this study was to conduct a systematic review and meta-analysis to estimate the cervical hrHPV prevalence in KTRs and to investigate the prevalence of HPV16 and HPV18 in KTRs. In addition, we compared the hrHPV prevalence in KTRs with that in immunocompetent controls.