Visceral and Cutaneous Leishmaniasis Recommendations for Solid Organ Transplant Recipients and Donors

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…VL is by far the most frequently encountered clinical presentation of leishmaniasis among SOT recipients described in kidney, liver, heart, lung, and pancreas transplantation [7,68,[79][80][81]. Fever is the most common symptom of VL, but in the study by Clemente et al, 14% of patients were afebrile [68,79].…”

“…It should be highlighted that in a recent case report of VL in a lung transplant recipient using real-time PCR which targets the kinetoplastic DNA, the authors were able to retrospectively detect the DNA of the parasite months before the diagnosis, suggesting the possibility to adopt a preemptive approach [97]. Leishmania serology has been reported to be positive in 76% of SOT patients with VL, but it is unable to distinguish between prior exposure and active disease; additionally, in areas where Chagas disease coexists, cross-reactivity can be a problem because both parasites share antigens [7,98].…”

“…Since there is not a clear demonstration of the utility of screening either among candidate organ transplant recipients or organ donors, available guidelines do not recommend this practice [7,99,100]. It is generally recommended that transplant recipients visiting endemic countries use insect repellent and avoid outdoor activities during the hours when sand flies are more active [7].…”

“…Since there is not a clear demonstration of the utility of screening either among candidate organ transplant recipients or organ donors, available guidelines do not recommend this practice [7,99,100]. It is generally recommended that transplant recipients visiting endemic countries use insect repellent and avoid outdoor activities during the hours when sand flies are more active [7]. Liposomal amphotericin B (L-AMB) is considered the drug of choice for the treatment of leishmaniasis in SOT with a cumulative dose of 40 mg/kg administered over 10 infusions (days 1-5 followed by one week administration for 5 times) [100].…”

“…Diagnosis and treatment of infections such as Chagas disease, malaria, and leishmaniasis in the setting of SOT is challenging due to multiple factors; to help clinicians to properly manage them, several guidelines and recommendations have been published in recent years [4][5][6][7][8][9]. The use of immunosuppressive drugs in transplant patients means that such protozoan infections not only can be acquired de-novo (by vectors, transfusion, and the organ transplanted), but can also undergo reactivation in those with latent infection due to the induced immunosuppression.…”