title: The risk factors for and effects of visceral leishmaniasis in graft and renal transplant recipients.
abstract: BACKGROUND
  The aim of this study was to identify the risk factors for visceral leishmaniasis (VL) in renal transplant recipients and to analyze the impacts of this disease on graft success and patient health.
  
  
  METHODS
  This retrospective, case-control study examined 120 renal transplant patients in a VL endemic area. The treatment group included patients (n=20) who developed VL after transplantation, and the control group (n=100) was composed of renal transplant recipients without VL. This study evaluated socioeconomic, demographic, clinical, and laboratory variables. Bivariate analysis and multiple logistic regressions were performed to identify potential risk factors.
  
  
  RESULTS
  The average time between transplantation and Leishmania infection in the treatment group was 29.4 months. Seventeen (85%) patients were cured and 3 (15%) died. In 95% of the cases, a myelogram was used for initial identification of Leishmania forms. The significant risk factors for VL in renal transplant recipients were cytomegalovirus infection after transplantation (odds ratio [OR], 5.29; 95% confidence interval [CI], 1.27-21.97) and living with cats (OR, 5.74; 95% CI, 1.15-28.76). Bacterial infection after transplantation (OR, 3.00; 95% CI, 0.96-9.37) and unpaved streets in the neighborhood (OR, 2.14; 95% CI, 0.71-6.43) tended to increase the risk of VL, whereas a negative Rh factor tended to protect against VL (OR, 0.26; 95% CI, 0.06-1.02).
  
  
  CONCLUSIONS
  Cytomegalovirus infection after transplantation and living with cats increased the risk of VL in renal transplant recipients living in VL endemic areas.
authors: Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil. avelaralvesdasilva@gmail.com
authors: Avelar
authors: A
authors: Alves da Silva
authors: Alvaro
authors: A
authors: Pacheco-Silva
authors: Ricardo
authors: R
authors: de Castro Cintra Sesso
authors: R M
authors: RM
authors: Esmeraldo
authors: Cláudia Maria
authors: CM
authors: Costa de Oliveira
authors: P F C B C
authors: PF
authors: Fernandes
authors: R A
authors: RA
authors: Oliveira
authors: L S V
authors: LS
authors: Silva
authors: Valencio P
authors: VP
authors: Carvalho
authors: Carlos Henrique
authors: CH
authors: Nery Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002415:Cats; D004285:Dogs; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D014881:Water Supply / Q000592:standards