Our Summary

In simpler terms, this research paper discusses the risk, incidence, and prevention of a disease called toxoplasmosis in patients who have undergone organ transplants other than the heart. Toxoplasmosis is an infection caused by a parasite, which is usually harmless but can cause serious problems in people with weakened immune systems, like organ transplant recipients.

In heart transplants, there’s a standard practice to protect against toxoplasmosis, particularly when the donor has been exposed to the parasite and the recipient has not. However, for transplants of other organs, there’s no agreed-upon prevention method.

The study found that cases of toxoplasmosis in non-heart transplant recipients are quite rare (less than 1%), but the true number is likely underestimated. It was most common in kidney and liver transplant patients, particularly those who had not been exposed to the parasite before the transplant but received an organ from a donor who had.

Most cases were seen in patients who weren’t being protected against the disease at the time they got sick. The study suggests that it’s beneficial to screen both donors and recipients for exposure to the parasite, as there have been fatal cases of toxoplasmosis when this information wasn’t available.

In conclusion, the paper suggests that prevention efforts should focus on high-risk groups and be considered for recipients with particularly weakened immune systems. The use of tests for antibodies and the parasite’s DNA should be used together to diagnose toxoplasmosis in non-heart transplant patients.

FAQs

  1. What is the incidence of toxoplasma disease in non-orthotopic heart transplant (non-OHT) recipients?
  2. What is the importance of screening for toxoplasma serology in donors and recipients?
  3. Should post-transplant prophylaxis be considered for seropositive recipients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart transplant is to be diligent about taking any prescribed medications, especially those related to preventing infections like toxoplasmosis. In cases where the patient is seronegative and receiving a heart from a seropositive donor, prophylaxis against toxoplasma should be considered to reduce the risk of infection. Regular screening for toxoplasma serology and PCR testing can also help in early detection and treatment of any potential infections.

Suitable For

Patients who are typically recommended for heart transplant are those with end-stage heart failure who have failed other medical and surgical treatments. These patients may have conditions such as coronary artery disease, cardiomyopathy, congenital heart defects, or valvular heart disease. Additionally, patients who have a high risk of mortality without a transplant, have a good chance of survival with a transplant, and are able to comply with the post-transplant care regimen are also considered for heart transplant.

Timeline

Before heart transplant:

  • Patient is diagnosed with end-stage heart failure and is evaluated by a transplant team
  • Patient undergoes extensive testing and assessments to determine if they are a suitable candidate for a heart transplant
  • Patient is placed on the transplant waiting list and waits for a suitable donor heart to become available
  • Patient may experience worsening symptoms and complications as they wait for a transplant

After heart transplant:

  • Patient undergoes surgery to receive the new donor heart
  • Patient is closely monitored in the intensive care unit for a period of time following the transplant
  • Patient begins a lifelong regimen of immunosuppressive medications to prevent rejection of the new heart
  • Patient undergoes regular follow-up appointments and testing to monitor the function of the new heart and adjust medications as needed
  • Patient may experience complications or side effects from the transplant and medications, and will need ongoing medical care and support

What to Ask Your Doctor

  1. What is the risk of developing toxoplasma disease after receiving a heart transplant?
  2. How common is toxoplasma disease in non-heart transplant recipients?
  3. What is the standard practice for toxoplasma prophylaxis in non-heart transplant recipients?
  4. Should I undergo universal screening for toxoplasma serology before receiving a heart transplant?
  5. What are the symptoms of toxoplasma disease and how is it diagnosed in non-heart transplant recipients?
  6. How effective is posttransplant prophylaxis against toxoplasma in high-risk recipient groups?
  7. Are there any specific precautions I should take to prevent toxoplasma infection after my heart transplant?
  8. How often should I be monitored for toxoplasma infection post-transplant?
  9. Are there any potential interactions between toxoplasma prophylaxis medications and my other post-transplant medications?
  10. What should I do if I experience any symptoms that could be related to toxoplasma infection after my heart transplant?

Reference

Authors: Dhakal R, Gajurel K, Montoya JG. Journal: Curr Opin Organ Transplant. 2018 Aug;23(4):407-416. doi: 10.1097/MOT.0000000000000550. PMID: 29878911