First case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation

Andrew L. Campbell, Cindy L. Goldberg, Margret S. Magid, Gabriel Gondolesi, Carolina Rumbo, Betsy Herold

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background. Toxoplasmosis prophylaxis is standard following heart and heart lung transplantation, when an increased risk of allograft transmitted Toxoplasma is well-recognized. In contrast, prophylaxis and routine serologic evaluation of donors and recipients for Toxoplasma in noncardiac solid organ transplantation (SOT) is not recommended. We report the first case of disseminated toxoplasmosis following small bowel transplantation, presumably transmitted via the transplanted intestine and systematically review reported cases of toxoplasmosis in noncardiac SOT recipients to determine if current guidelines should be reconsidered. Methods. Systematic MEDLINE review was performed for tissue invasive toxoplasmosis in noncardiac SOT recipients and analysis of clinical features, serologic status, and treatment regimens with respect to mortality. Results. Fifty-two cases of toxoplasmosis in noncardiac SOT recipients were identified. Eighty-six percent developed disease within 90 days of transplantation. Presentation was nonspecific and consisted of fever (77%), respiratory distress (29%), neurologic manifestations (29%), and bone marrow suppression (26%). Multivariate analyses demonstrated that localized disease (odds ratio [OR] = 37.36, 95% CI 1.85-754.85), treatment received (OR = 1.814, 95% CI 1.193-3.480) and donor and recipient serostatus (OR = 1.39, 95% CI 1.068-1.815) were predictors of survival. High-risk recipients (donor seropositive/recipient seronegative) developed disease earlier (16 days vs. 31 days P = 0.002) and were less likely to survive (OR = 0.14, 95% CI 0.03-0.69) than standard-risk recipients. Conclusions. Toxoplasmosis is recognized following noncardiac SOT. Reduction of morbidity and mortality necessitates knowledge of donor and recipient Toxoplasma serostatus, prophylaxis, early diagnosis, and treatment. The findings support a reconsideration of pretransplantation evaluation and prophylaxis strategies in SOT recipients.

Original languageEnglish (US)
Pages (from-to)408-417
Number of pages10
JournalTransplantation
Volume81
Issue number3
DOIs
StatePublished - Feb 2006
Externally publishedYes

Fingerprint

Toxoplasmosis
Organ Transplantation
Transplantation
Toxoplasma
Odds Ratio
Heart-Lung Transplantation
Mortality
Neurologic Manifestations
MEDLINE
Intestines
Allografts
Early Diagnosis
Fever
Multivariate Analysis
Bone Marrow
Guidelines
Morbidity

Keywords

  • Opportunistic infections
  • Small bowel transplant
  • Systematic review
  • Toxoplasmosis
  • Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

First case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation. / Campbell, Andrew L.; Goldberg, Cindy L.; Magid, Margret S.; Gondolesi, Gabriel; Rumbo, Carolina; Herold, Betsy.

In: Transplantation, Vol. 81, No. 3, 02.2006, p. 408-417.

Research output: Contribution to journalArticle

Campbell, Andrew L. ; Goldberg, Cindy L. ; Magid, Margret S. ; Gondolesi, Gabriel ; Rumbo, Carolina ; Herold, Betsy. / First case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation. In: Transplantation. 2006 ; Vol. 81, No. 3. pp. 408-417.
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abstract = "Background. Toxoplasmosis prophylaxis is standard following heart and heart lung transplantation, when an increased risk of allograft transmitted Toxoplasma is well-recognized. In contrast, prophylaxis and routine serologic evaluation of donors and recipients for Toxoplasma in noncardiac solid organ transplantation (SOT) is not recommended. We report the first case of disseminated toxoplasmosis following small bowel transplantation, presumably transmitted via the transplanted intestine and systematically review reported cases of toxoplasmosis in noncardiac SOT recipients to determine if current guidelines should be reconsidered. Methods. Systematic MEDLINE review was performed for tissue invasive toxoplasmosis in noncardiac SOT recipients and analysis of clinical features, serologic status, and treatment regimens with respect to mortality. Results. Fifty-two cases of toxoplasmosis in noncardiac SOT recipients were identified. Eighty-six percent developed disease within 90 days of transplantation. Presentation was nonspecific and consisted of fever (77{\%}), respiratory distress (29{\%}), neurologic manifestations (29{\%}), and bone marrow suppression (26{\%}). Multivariate analyses demonstrated that localized disease (odds ratio [OR] = 37.36, 95{\%} CI 1.85-754.85), treatment received (OR = 1.814, 95{\%} CI 1.193-3.480) and donor and recipient serostatus (OR = 1.39, 95{\%} CI 1.068-1.815) were predictors of survival. High-risk recipients (donor seropositive/recipient seronegative) developed disease earlier (16 days vs. 31 days P = 0.002) and were less likely to survive (OR = 0.14, 95{\%} CI 0.03-0.69) than standard-risk recipients. Conclusions. Toxoplasmosis is recognized following noncardiac SOT. Reduction of morbidity and mortality necessitates knowledge of donor and recipient Toxoplasma serostatus, prophylaxis, early diagnosis, and treatment. The findings support a reconsideration of pretransplantation evaluation and prophylaxis strategies in SOT recipients.",
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T1 - First case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation

AU - Campbell, Andrew L.

AU - Goldberg, Cindy L.

AU - Magid, Margret S.

AU - Gondolesi, Gabriel

AU - Rumbo, Carolina

AU - Herold, Betsy

PY - 2006/2

Y1 - 2006/2

N2 - Background. Toxoplasmosis prophylaxis is standard following heart and heart lung transplantation, when an increased risk of allograft transmitted Toxoplasma is well-recognized. In contrast, prophylaxis and routine serologic evaluation of donors and recipients for Toxoplasma in noncardiac solid organ transplantation (SOT) is not recommended. We report the first case of disseminated toxoplasmosis following small bowel transplantation, presumably transmitted via the transplanted intestine and systematically review reported cases of toxoplasmosis in noncardiac SOT recipients to determine if current guidelines should be reconsidered. Methods. Systematic MEDLINE review was performed for tissue invasive toxoplasmosis in noncardiac SOT recipients and analysis of clinical features, serologic status, and treatment regimens with respect to mortality. Results. Fifty-two cases of toxoplasmosis in noncardiac SOT recipients were identified. Eighty-six percent developed disease within 90 days of transplantation. Presentation was nonspecific and consisted of fever (77%), respiratory distress (29%), neurologic manifestations (29%), and bone marrow suppression (26%). Multivariate analyses demonstrated that localized disease (odds ratio [OR] = 37.36, 95% CI 1.85-754.85), treatment received (OR = 1.814, 95% CI 1.193-3.480) and donor and recipient serostatus (OR = 1.39, 95% CI 1.068-1.815) were predictors of survival. High-risk recipients (donor seropositive/recipient seronegative) developed disease earlier (16 days vs. 31 days P = 0.002) and were less likely to survive (OR = 0.14, 95% CI 0.03-0.69) than standard-risk recipients. Conclusions. Toxoplasmosis is recognized following noncardiac SOT. Reduction of morbidity and mortality necessitates knowledge of donor and recipient Toxoplasma serostatus, prophylaxis, early diagnosis, and treatment. The findings support a reconsideration of pretransplantation evaluation and prophylaxis strategies in SOT recipients.

AB - Background. Toxoplasmosis prophylaxis is standard following heart and heart lung transplantation, when an increased risk of allograft transmitted Toxoplasma is well-recognized. In contrast, prophylaxis and routine serologic evaluation of donors and recipients for Toxoplasma in noncardiac solid organ transplantation (SOT) is not recommended. We report the first case of disseminated toxoplasmosis following small bowel transplantation, presumably transmitted via the transplanted intestine and systematically review reported cases of toxoplasmosis in noncardiac SOT recipients to determine if current guidelines should be reconsidered. Methods. Systematic MEDLINE review was performed for tissue invasive toxoplasmosis in noncardiac SOT recipients and analysis of clinical features, serologic status, and treatment regimens with respect to mortality. Results. Fifty-two cases of toxoplasmosis in noncardiac SOT recipients were identified. Eighty-six percent developed disease within 90 days of transplantation. Presentation was nonspecific and consisted of fever (77%), respiratory distress (29%), neurologic manifestations (29%), and bone marrow suppression (26%). Multivariate analyses demonstrated that localized disease (odds ratio [OR] = 37.36, 95% CI 1.85-754.85), treatment received (OR = 1.814, 95% CI 1.193-3.480) and donor and recipient serostatus (OR = 1.39, 95% CI 1.068-1.815) were predictors of survival. High-risk recipients (donor seropositive/recipient seronegative) developed disease earlier (16 days vs. 31 days P = 0.002) and were less likely to survive (OR = 0.14, 95% CI 0.03-0.69) than standard-risk recipients. Conclusions. Toxoplasmosis is recognized following noncardiac SOT. Reduction of morbidity and mortality necessitates knowledge of donor and recipient Toxoplasma serostatus, prophylaxis, early diagnosis, and treatment. The findings support a reconsideration of pretransplantation evaluation and prophylaxis strategies in SOT recipients.

KW - Opportunistic infections

KW - Small bowel transplant

KW - Systematic review

KW - Toxoplasmosis

KW - Transplantation

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