Toxoplasma gondii is an important cause of morbidity and mortality in solid organ transplant recipients. Patients with a serologic mismatch (donor positive/ recipient negative) are at higher risk for toxoplasmosis, and prophylaxis has been effective for certain solid organ transplant recipients. The incidence of toxoplasma mismatch and the efficacy of prophylaxis have not been studied in lung transplant recipients. Our aim is to determine the incidence of T. gondii serologic mismatch in the lung transplant population and report the incidence of toxoplasmosis in patients receiving pyrimethamine and leukovorin prophylaxis.
This study is a retrospective review of all lung transplant recipients at a tertiary center over an 8-year period (1995-2002). Data collected includes patient demographics, toxoplasma serologies, prophylaxis regimen, adverse effects due to prophylaxis, occurrence of toxoplasmosis, and time of death post-transplant. We report the incidence of T. gondii mismatch and toxoplasmosis.
Over an 8-year period, 246 lung transplants were performed. The average age of these recipients was 47.6 years. 26 of 246 patients (10.8%) had a serologic mismatch for T. gondii. 15 were women and 11 were men. All patients received prophylaxis with pyrimethamine 50 mg qd and leukovorin 10 mg qd for 6 months. There were no cases of toxoplasmosis in the mismatch group. There were no significant adverse effects attributed to the prophylaxis regimen. There were 10 deaths in the mismatch group, with an average survival of 447.5 days post-transplant.CONCLUSIONS: We observe a low incidence of toxoplasma mismatch in lung transplant recipients, similar to the reported incidence in other solid organ recipients. Prophylaxis with pyrimethamine and leukovorin in lung transplant recipients mismatched for T. gondii is effective and well tolerated.
Toxoplasma mismatch is relatively uncommon in the lung transplant population, but prophylaxis, when indicated, is effective.
A. Gaggar, None.