Toxoplasma Gondii Serostatus in Heart Transplant Recipients: Is It an Independent Prognostic Factor?
OBJECTIVE
To assess the potential association between recipient Toxoplasma gondii serostatus and outcomes after heart transplant (HT).


METHODS
We conducted a retrospective single-center study of 657 HT recipients from 1991 to 2015. Survival and the incidence of adverse clinical events of T. gondii-seropositive (n = 481) vs T. gondii-seronegative (n = 176) recipients were compared by means of 2 different multivariable Cox regression models. Model 1 included solely age and sex, and model 2 included other potential confounders.


RESULTS
Over a median follow-up of 2903 days (interquartile range: 898-4757), 250 seropositive recipients (52%) and 72 seronegative recipients (41%) died. Univariable analysis showed increased posttransplant mortality among T. gondii-seropositive recipients (hazard ratio [HR] = 1.31; 95% confidence interval [95%CI], 1,00-1.70). After multivariable adjustment, the statistical significance of this association was lost (model 1: HR = 1.09; 95%CI, 0.83-1.43; model 2:HR = 1.12; 95%CI, 0.85-1.47). Recipient T. gondii seropositivity was independently associated with an increased risk of acute rejection (model 1: HR = 1.36; 95%CI, 1.06-1.74; model 2: HR = 1.29; 95%CI, 1.01-1.66). Multivariable models showed no statistically significant impact of recipient T. gondii serostatus on the incidence of infection, malignancy, coronary allograft vasculopathy, or the composite outcome of cardiac death or retransplant. No significant association was found between donor-recipient T. gondii serostatus matching and posttransplant outcome.


CONCLUSIONS
In this study, recipient T. gondii serostatus was not an independent predictor of long-term post-HT outcome.
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: eduardo.barge.caballero@sergas.es.
Eduardo
E
Barge-Caballero
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Cayetana
C
Barbeito-Caamaño
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Gonzalo
G
Barge-Caballero
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
David
D
Couto-Mallón
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
María J
MJ
Paniagua-Martín
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Raquel
R
Marzoa-Rivas
Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Miguel
M
Solla-Buceta
Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Francisco
F
Estévez-Cid
Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
José M
JM
Herrera-Noreña
Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
José J
JJ
Cuenca-Castillo
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
José M
JM
Vázquez-Rodríguez
Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
María G
MG
Crespo-Leiro
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014122:Toxoplasma / Q000276:immunology*; D014123:Toxoplasmosis / Q000453:epidemiology* / Q000276:immunology
D007166:Immunosuppressive Agents
Heart transplant; Outcomes; Pronóstico; Supervivencia; Survival; Toxoplasma gondii; Trasplante cardiaco