*Purpose: Human papillomavirus-related anogenital malignancies disproportionately affect solid organ transplant recipients (SOTR) compared to the general population. Proposed cervical Pap testing intervals for SOTR differ between organizations and across medical specialties. We compared observed frequency of cervical cancer screening post-transplant to annual expected frequency in female SOTR.

*Methods: A retrospective review of 216 liver, kidney, or liver-kidney graft recipients was performed to compare observed to expected frequency of Pap screening after transplant between January 1, 2011 and December 31, 2019. Secondary outcomes included frequency of atypical Pap smears, specialty most often performing Pap tests, most common recommended screening interval documented by institutional transplant providers, frequency of Gardasil vaccination in patients prior to transplant, and whether frequency of screening was related to certain socioeconomic factors. Univariate statistics (Wilcoxon signed-rank, chi-square) were performed for all comparisons.

*Results: Screening records were available for 109/216 (50.5%) of the female subjects included. Of these, 18 (16.5%) met or exceeded the expected number of Pap screenings. 26/91 (28.6%) women had irregular Pap screening after transplant, with 3/26 (11.5%) having cytology consistent with high-grade squamous intraepithelial lesion. 1.4% (3/216) of patients were documented as having received Gardasil vaccination prior to transplantation. In 203/216 (94%) of patients, it was unknown whether Gardasil was offered prior to transplant and 133/216 (61.6%) of patients had no mention of Gardasil in their electronic medical record. A recommended screening interval of every 3-5 years was most commonly documented in transplant notes (67/184, 36.4%). Pap screenings were primarily performed by OBGYN (76/91, 83.5%). No statistically significant correlation existed between frequency of Pap screenings and patient race, marital status, economic hardship, home support, or mental health status.

*Conclusions: Approximately one-half of women lacked record of cervical cancer screening and few of those with documented Paps met annual recommended screening per transplant society guidelines. Screening recommendations vary widely, impressing the need for education at the provider level and systems-level tools to support evidence-based cancer screening.

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