Toxoplasmosis in Transplant Recipients, Europe, 2010–2014

Abstract

Transplantation activity is increasing, leading to a growing number of patients at risk for toxoplasmosis. We reviewed toxoplasmosis prevention practices, prevalence, and outcomes for hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT; heart, kidney, or liver) patients in Europe. We collected electronic data on the transplant population and prevention guidelines/regulations and clinical data on toxoplasmosis cases diagnosed during 2010–2014. Serologic pretransplant screening of allo-hematopoietic stem cell donors was performed in 80% of countries, screening of organ donors in 100%. SOT recipients were systematically screened in 6 countries. Targeted anti-Toxoplasma chemoprophylaxis was heterogeneous. A total of 87 toxoplasmosis cases were recorded (58 allo-HSCTs, 29 SOTs). The 6-month survival rate was lower among Toxoplasma-seropositive recipients and among allo-hematopoietic stem cell and liver recipients. Chemoprophylaxis improved outcomes for SOT recipients. Toxoplasmosis remains associated with high mortality rates among transplant recipients. Guidelines are urgently needed to standardize prophylactic regimens and optimize patient management.

Toxoplasmosis in non‐cardiac solid organ transplant recipients: A case series and review of literature

“…Toxoplasmosis is a life‐threatening infection among immunocompromised hosts, especially hematopoietic stem cell transplant (HSCT) and SOT recipients . Severe infection among SOT recipients is often graft transmitted and occurs in D+/R− recipients, whereas it is due to reactivation in high‐risk R + HSCT recipients .…”

“…The clinical presentation of toxoplasmosis among SOT recipients is non‐specific. Patients may initially present with fever, but infection often rapidly progresses to involve multiple organ systems, with pulmonary, cerebral, and disseminated infection commonly described . Due to its varied clinical presentation, laboratory tools are necessary to confirm the diagnosis of toxoplasmosis.…”

“…Toxoplasma serology (IgM and IgG) may be difficult to interpret due to its lower sensitivity among immunosuppressed patients . In an European study of 87 reported cases of toxoplasmosis among HSCT and SOT recipients, PCR helped diagnose 77 cases (89%) followed by imaging, 32 cases (37%) and serology, 28 cases(32%) . As demonstrated in cases 2 and 3, the role of testing Toxoplasma IgG instead of PCR in the post‐transplant period has limited value in the diagnosis of toxoplasmosis.…”

“…The study concluded that donor‐derived toxoplasmosis may be more common than previously appreciated in non‐OHT recipients . Robert‐Gangneux et al identified 29 cases (heart, n = 12, liver, n = 8, kidney, n = 9) of toxoplasmosis among SOT recipients from 46 transplant centers in 11 European countries between 2010 and 2014. Notably, 59% (17/29) of cases occurred in non‐cardiac SOT recipients and 46% (11/24) of all D+/R− SOT recipients developed toxoplasmosis in this study.…”

Identification of disseminated toxoplasmosis by plasma next‐generation sequencing in a teenager with rapidly progressive multiorgan failure following haploidentical stem cell transplantation

“…In a series of 23 HSCT patients with toxoplasmosis disease, 87% were seropositive prior to transplant . Prophylaxis for seropositive high‐risk patients has been shown to prevent disease . At our center, we now screen donors and recipients pretransplant, monitor seropositive patients with PCR testing during the peri‐transplant time period, and institute prophylaxis with neutrophil engraftment.…”