Long‐term outcome after liver transplantation for hepatic schistosomiasis: A single‐center experience over 15 years

Abstract

Our objective was to study the long-term outcomes of patients who had undergone liver transplantation because of schistosomiasis at our institute over the last 15 years. Four hundred forty-one patients underwent liver transplantation at our institute, and 14 did so for schistosomiasis. The survival of patients who underwent transplantation for schistosomiasis was compared with that of patients who underwent transplantation for other liver diseases. Survival curves were drawn via the Kaplan-Meier method and were compared with the log-rank test. P < 0.05 was considered significant. All 14 patients were male, and the average age was 56.8 6 8.4 years. The average Model for End-Stage Liver Disease score was 18.2 6 5.6, and the average Child-Pugh score was 10.6 6 1.2. All patients had splenomegaly; pretransplant variceal bleeding occurred in 7 patients (50%), and portal vein thrombosis was diagnosed in 5 patients (36%). Patient survival was 75% 1 year after transplantation and 75% at the end of follow-up because no patients were lost after the first year. Patients who underwent transplantation for other causes achieved survival rates of 86% and 76% 1 and 10 years after transplantation, respectively. There was no significant survival difference between the 2 groups (P 5 0.66). All patients who survived the early posttransplant period had functioning liver grafts with no reported diagnoses of schistosomiasis in the new grafts. In conclusion, liver transplantation for patients with schistosomiasis has a favorable outcome with no risk of reactivation. Liver Transpl 21:96-100, 2015. V C 2014 AASLD.Received June 22, 2014; accepted September 14, 2014.Schistosomiasis results from long-lived infections by trematode blood flukes of the genus Schistosoma. 1 It remains one of the world's most prevalent diseases and affects more than 200 million people. The genus has 5 species, 4 of which can lead to hepatic disease. 1,2 In Saudi Arabia, the prevalence of schistosomiasis is 2.78/100,000; 75% of those affected have intestinal schistosomiasis. Approximately 55% of cases are discovered among Saudi individuals, and 45% are among non-Saudi individuals. Two species, Schistosoma mansoni and Schistosoma haematobium, are endemic in Saudi Arabia. 3 The adult S. mansoni worms reside in mesenteric veins of the bowel and produce emboli of ova moving to the liver; this results in a chronic inflammatory reaction, presinusoidal inflammation, periportal fibrosis, and portal hypertension. This sequence occurs in fewer than 10% of patients who have chronic infections and takes many years to develop. Progressive periportal fibrosis, severe portal hypertension, variceal bleeding, huge splenomegaly, and hypersplenism are characteristic features of hepatic schistosomiasis. 4 These changes are related to sustained heavy infections over many years. Despite this, hepatocellular function is preserved until the late stage of the disease. 4,5 Liver transplantation represents the definitive treatment for end-stage liver disease. 1 Several reports have discusse...

Post‐transplant liver graft schistosomiasis in a migrant from Sub‐Saharan Africa

“…Along with other parasitic infections, such as Chagas disease and strongyloidiasis, schistosomiasis may have several implications for solid organ transplant patients. Hepatic schistosomiasis due to S. mansoni and S. japonicum may lead to progressive fibrosis and portal hypertension . Even though the hepatocellular function is preserved until the late stage of disease, liver transplantation may be indicated for end‐stage disease .…”

“…Hepatic schistosomiasis due to S. mansoni and S. japonicum may lead to progressive fibrosis and portal hypertension . Even though the hepatocellular function is preserved until the late stage of disease, liver transplantation may be indicated for end‐stage disease . In a transplant center in Saudi Arabia, S. mansoni was indication to liver transplantation for 3% of patients undergoing liver transplantation .…”

“…Even though the hepatocellular function is preserved until the late stage of disease, liver transplantation may be indicated for end‐stage disease . In a transplant center in Saudi Arabia, S. mansoni was indication to liver transplantation for 3% of patients undergoing liver transplantation . In patients with S. haematobium infection, renal impairment is primarily caused by obstruction, reflux, and stone formation related to fibrosis and calcification of tissue‐trapped ova in the lower urinary tract .…”

“…In Egypt, schistosomiasis accounts for 10% of chronic renal failure cases and ranks second after diabetes mellitus among all causes of chronic renal failure . If appropriately treated before transplantation, patients with schistosomiasis undergoing kidney or liver transplantation have outcomes comparable to patients transplanted for other indications . However, renal transplant recipients with schistosomiasis are reported to require higher dose of cyclosporine with subsequent higher incidence of nephrotoxicity, urinary tract infections, and complications …”

“…8 In a transplant center in Saudi Arabia, S. mansoni was indication to liver transplantation for 3% of patients undergoing liver transplantation. 8 In patients with S. haematobium infection, renal impairment is primarily caused by obstruction, reflux, and stone formation related to fibrosis and calcification of tissue-trapped ova in the lower urinary tract. 9 Amyloidosis and glomerulonephritis may develop in S. haematobium or S. mansoni infection as a consequence of immune complexes containing worm antigens deposited in the glomeruli.…”