Pre-Transplant Serology, Lung Nodules, Calcified Mediastinal Lymph Nodes, and the Risk of Histoplasmosis after Liver Transplantation

S. H. KANG, P. J. DAZIEL, R. R. RAZONABLE;

Author address: 

Mayo Clinic, Rochester, MN.

Abstract: 

Background: Transplant recipients are at increased risk of histoplasmosis. Transplant candidates residing in hyperendemic regions were screened by serology and chest radiographs and followed clinically for histoplasma disease after liver transplantation. Methods: The medical records of adult patients who received liver transplant at a large Midwestern US Transplant Center between January 2005 and December 2008 were reviewed. Results: During the 4-year study, a total of 381 patients underwent 390 liver transplant procedures. Of these, 104 patients (27.6%) were screend with histoplasma serology prior to transplant. All except 3 patients resided in regions hyperendemic for Histoplasma capsulatum. Eleven (10.6%) had positive histoplasma screen and two (1.9%) were also positive by complement fixation. One patient with a positive histoplasma serology received itraconazole prophylaxis for 3 months after transplant while all others did not receive antifungal prophylaxis. One patient with positive histoplasma screen but negative complement fixation test developed disseminated histoplasmosis two months after liver transplantation (overall incidence 0.26%; incidence in histoplasma-seropositive group, 10.9%). Twenty-six patients had pre-transplant lung nodules or calcified mediastinal lymph nodes and no one developed histoplasmosis. Two patients with prior probable histoplasmosis were seronegative prior to transplant and did not develop reactivation disease after transplantation. Conclusion: Histoplasmosis is uncommon among liver recipients who reside in hyperendemic regions, including those with evidence of prior disease. Neither a positive pre-transplant serology nor evidence of prior disease was associated with post-transplant histoplasmosis. Hence, we discourage the routine use of histoplasma serology to screen transplant candidates in hyperendemic regions, even with evidence of prior infection.
2009

abstract No: 

M-1025

Full conference title: 

49th Annual ICAAC
    • ICAAC 49th