Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases

Abstract

Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas.

Descriptive study on risk of increased morbidity of schistosomiasis and graft loss after liver transplantation

“…Any clinical or laboratory test abnormality was considered as an indicator of morbidity, requiring careful investigation in a few cases. Abnormal liver enzyme levels were only transiently detected in three patients, demonstrating an active granulomatous reaction and S.mansoni eggs 25 , 26 . In two recipients and one infected graft, morbidity caused by parasitic infection was suspected but not confirmed 31 , 33 , 38 .…”

“…Among the 43 reported cases examined in the present study ( Table 1 ), evidence for a role of schistosomiasis in increased morbidity and graft loss was weak. For example, the possibility was only considered for six of the patients, but without confirmation 31 , 33 , 38 or with complete recovery from liver enzyme abnormalities 25 , 26 . Contrary to early stage granuloma and non-degenerated eggs 25 , 26 , epithelioid or calcified granulomas do not represent evidence of a significant contribution to failure of transplantation 31 , 38 .…”