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Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

2019; Wiley; Volume: 33; Issue: 4 Linguagem: Inglês

10.1111/ctr.13497

1399-0012

José F. Camargo, Jacques Simkins, Shweta Anjan, Giselle Guerra, Rodrigo Vianna, Sam Salama, Carla Albright, Elizabeth Shipman, José G. Montoya, Michele I. Morris, Lilian M. Abbo,

Research on Leishmaniasis Studies

Abstract Background Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor‐derived Strongyloides infection has occurred after heart, kidney, kidney‐pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis. Methods We report a fatal case of donor‐derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation. Results From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody‐positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post‐transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center. Conclusions Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient‐ and donor‐derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.