title: Pre-transplant Toxoplasma gondii seropositivity among heart transplant recipients is associated with an increased risk of all-cause and cardiac mortality.
abstract: OBJECTIVE
  We evaluated the risk of mortality, development of cardiac allograft vasculopathy (CAV), and acute cellular rejection among Toxoplasma gondii (T. gondii) seropositive heart transplant (HTx) recipients and the 4 donor/recipient seropairing groups.
  
  
  BACKGROUND
  Chronic T. gondii infection is known to trigger potentially adverse immunoregulatory changes, but the long-term implication for HTx recipients has not been assessed previously.
  
  
  METHODS
  Frozen pre-HTx serum samples of 288 recipients and 246 donors were evaluated for T. gondii serostatus using Platelia immunoglobulin G immunoassay. Patients had undergone prospective serotesting using alternative assays, and results determined by the 2 methods were compared. Data regarding mortality, CAV, and acute cellular rejection were available for all patients.
  
  
  RESULTS
  Overall, 211 recipients (73%) were seronegative and 77 (27%) were seropositive. In total, 82 recipients died, 76 developed CAV, and 82 had 1 or more episode of treated cellular rejection. Recipient seropositivity was associated with a significantly higher risk of all-cause (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1 to 3.4; p = 0.02) and CAV mortality (HR 4.4, 95% CI 1.3 to 15.6; p = 0.02) and a higher risk of developing advanced CAV (HR 2.7, 95% CI 1.2 to 5.8; p = 0.01). Seropositivity did not influence the number of rejection episodes, and donor/recipient seropairing was not a risk factor for any end point.
  
  
  CONCLUSIONS
  T. gondii seropositivity among HTx recipients is associated with an increased risk of all-cause and CAV mortality and of development of advanced CAV. This may be mediated via immunoregulatory changes triggered by chronic T. gondii infection and needs to be explored further.
authors.affiliation: Department of Cardiology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. satish.arora@medisin.uio.no
authors.forename: Satish
authors.initials: S
authors.lastname: Arora
authors.forename: Pål A
authors.initials: PA
authors.lastname: Jenum
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.forename: Halvor
authors.initials: H
authors.lastname: Rollag
authors.forename: Arne K
authors.initials: AK
authors.lastname: Andreassen
authors.forename: Svein
authors.initials: S
authors.lastname: Simonsen
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.forename: Arnt E
authors.initials: AE
authors.lastname: Fiane
authors.forename: Odd
authors.initials: O
authors.lastname: Geiran
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality* / Q000469:parasitology; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000382:microbiology; D016027:Heart Transplantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D014122:Toxoplasma / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000097:blood / Q000401:mortality / Q000469:parasitology