Abstract: PO2460
Two Deaths of Acute Transplant Patients from Strongyloides Hyperinfection Syndrome (SHS): Can We Prevent Harm with Screening and Prophylaxis at the Time of Transplantation?
Session Information
- Transplant Complications: Infection
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Hawkins-van der Cingel, Gerlineke Mc, Royal London Hospital, London, London, United Kingdom
- Sekhawat, Vivek, Royal London Hospital, London, London, United Kingdom
- Ahmed, Rafez M., Royal London Hospital, London, London, United Kingdom
- Rajakariar, Ravindra, Royal London Hospital, London, London, United Kingdom
Background
A 59 year old Vietnamese man presented with non-specific abdominal pain 8 weeks after a deceased donor kidney transplant. He was thoroughly investigated and no cause for the pain identified. On day three of the admission he became febrile and hypoxic. He died with multi-organ failure. Within three months a patient of Congolese origin presented nine weeks post transplant with abdominal pain. He became febrile with gram positive bacteraemia and was admitted to the ICU with type 1 respiratory failure where he unfortunately died. Autopsy findings revealed SHS.
These cases were patients at a transplant centre in a non-endemic area albeit with an ethnically diverse population. A survey of other UK transplant centres showed that none did pre-transplant screening for strongyloides infection.
Methods
As a result of these cases we implemented and evaluated a program to screen for and prophylactically treat Strongyloides infection:
Live donor patients were screened with Strongyloides serology in advance of transplantation. All recipients of deceased donor transplants were screened on admission for their transplant unless they had never travelled to an endemic area. At induction recipients received a weight adjusted dose of Ivermectin pending serology results. If positive a second prophylactic dose was administered at day 14. Travel histories and demographic data were recorded.
Results
Between July 2019 and March 2020; 135 patients were transplanted at our unit. Of those 125 had strongyloides serology testing; eight were positive at time of transplant with an additional two patients reported as "borderline". One further patient tested positive on a previous admission for a transplant which was cancelled; but was negative on the admission of the successful transplant. This indicates that at least 8% of our transplant listed patients are positive for strongyloides infection. By May 2020 there were no recorded deaths due to SHS, or morbidity associated with strongyloides infection in this group.
Conclusion
We have demonstrated that there is a significant level of sero-positivity within our pre-transplant population and that a relatively low-cost strategy may help prevent the potentially fatal Strongyloides Hyperinfection Syndrome.