title: Toxoplasma gondii Serology and Outcomes After Heart Transplantation: Contention in the Literature.
abstract: BACKGROUND
  Toxoplasma gondii is an endemic pathogen to which approximately half of healthy patients develop antibodies. Toxoplasma serology is routinely assessed prior to heart transplantation. It has been suggested that donor or recipient toxoplasma serologic status may be associated with poor long-term outcomes post-transplantation, but current literature reveals conflicting results.
  
  
  METHODS
  From 1995 to 2012 at our single center, we retrospectively reviewed 785 heart transplant patients for pre-transplantation T. gondii serology. Patients were divided into T. gondii seronegative and seropositive groups. Subgroups in each group were created based on whether the donor was seropositive or seronegative. We assessed survival, freedom from nonfatal major adverse cardiac events, and freedom from cardiac allograft vasculopathy at 5 years post-transplantation.
  
  
  RESULTS
  No significant difference was found between 5-year outcomes of pre-transplant T. gondii seronegative and T. gondii seropositive recipients post-heart transplantation. However, in the donor-seropositive/recipient-seronegative subgroup (D+/R-), there was a significantly lower 5-year survival rate compared to the cohort of donor-seronegative/recipient-seronegative (D-/R-) patients (60% vs 87%, P = .04). After adjustment by multivariate analysis, D+/R- status conferred a trend towards increased mortality (HR 3.0, P = .06).
  
  
  CONCLUSIONS
  Toxoplasma serology prior to heart transplantation does not appear to impact post-transplantation outcome. However, toxoplasma seronegative patients who receive toxoplasma seropositive hearts appear to have poorer 5-year survival compared to toxoplasma seronegative patients who received toxoplasma seronegative hearts. Due to the small sample size, the association between T. gondii serology mismatch and long-term survival warrants further study.
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: A
authors: A
authors: Chehrazi-Raffle
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: M
authors: M
authors: Luu
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: Z
authors: Z
authors: Yu
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: F
authors: F
authors: Liou
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: M
authors: M
authors: Kittleson
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States.
authors: M
authors: M
authors: Hamilton
authors: Cedars-Sinai Heart Institute, Los Angeles, Calif., United States. Electronic address: Kobashigawaj@cshs.org.
authors: J
authors: J
authors: Kobashigawa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000469:parasitology / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D014122:Toxoplasma / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000175:diagnosis*