Visceral Leishmaniasis (Kala‐azar) in Solid Organ Transplantation: Report of Five Cases and Review

Abstract

Visceral leishmaniasis is an infectious disease that occurs only rarely in recipients of solid organ grafts but is associated with an elevated mortality rate despite proper treatment. We report five cases diagnosed in our hospital. All the patients were men aged 30 to 60 years who had undergone kidney transplantation (3 patients), heart transplantation (1), or liver transplantation (1). Three of the patients died, one had multiple recurrences, and one developed post-kala-azar cutaneous leishmaniasis. We review the clinical features, treatments, and outcomes of 26 previously reported cases, pointing out the lower cure rate associated with human immunodeficiency virus infection.

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…Confirmation of the parasite in bone marrow or splenic aspirate via direct microscopy after staining with Giemsa or culture in Novy-MacNeal-Nicholl or other media provides a definitive diagnosis. In the majority of cases of VL in transplant patients, diagnosis has been made by the detection of parasites in bone marrow biopsies (21,27,164,319). The most widely used serological techniques to detect anti-Leishmania antibodies are IFAT, ELISA, and direct agglutination tests.…”

“…for blood or organ donors is not performed, even in areas of high endemicity. Third, a previously infected recipient may reactivate latent infection in the posttransplant period; this is believed to be the mechanism responsible for most cases of transplant-related leishmaniasis (27,164,319). Leishmania serology is not performed routinely in transplant recipients.…”

“…Over 60 cases of VL in SOT recipients have been described (14,27,136,164,176,184,251,274,319,342), with the majority occurring in renal transplant patients. This correlates with the increased number of renal transplants performed compared to other organs.…”

“…According to several authors, the number of cases may well be underestimated. The majority of transplant patients who developed VL were originally from an area of endemicity (one-third of cases have been reported in Spain) or had a history of travel to areas of endemicity (164,319).…”

“…The difficulties in diagnosing these patients who may present with atypical symptoms due to immune suppression and the consequent delay in diagnosis and treatment explain the high resulting mortality in this context (up to 20 to 30%) (27,164,319).…”