title: Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis.
abstract: BACKGROUND
  Donor-derived Strongyloides stercoralis infection in solid organ transplant (SOT) recipients is uncommon. Immunosuppressed SOT recipients are at risk of developing severe forms of strongyloidiasis infection through transmission from an infected donor allograft.
  
  
  METHODS
  PubMed was searched for English-written articles published up to April 2015. Articles that reported cases of donor-derived strongyloidiasis infection in SOT recipients were reviewed for a pooled analysis.
  
  
  RESULTS
  A total of 27 cases were identified from various SOT recipients. Donors were mostly from Strongyloides endemic regions (23 cases). No transplant recipients received prophylaxis against strongyloidiasis infection. Median age was 53 years. Median time of presenting symptoms after the solid organ transplantation was 72 days. The most common presenting symptoms were gastrointestinal (GI) symptoms (19 cases; 70.4%). Diagnosis of strongyloidiasis infection was mainly made by the confirmation of Strongyloides larvae or worm in GI samples (19 cases) and respiratory samples (14 cases). Donor-derived strongyloidiasis infection was evidenced by serology test results in 17 cases and epidemiological risk assessment analysis in 10 cases. Ivermectin was the most commonly used medication with use of a combination of iverrmectin and albendazole or thiabendazole in 15 cases. Death was noted in 9 cases (34.6%) of 26 cases with known outcomes. Presence of sepsis or bacteremia was a predictor of mortality because it was seen in 9 patients who died (100.0%) and in 4 patients who survived (23.5%; P < .001).
  
  
  CONCLUSIONS
  Donor-derived strongyloidiasis infection in SOT recipients has high mortality. Effective donor screening and prophylaxis in high-risk SOT recipients may help to decrease morbidity and mortality associated with donor-derived strongyloidiasis.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: kimds1@korea.ac.kr.
authors.forename: D S
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Y K
authors.initials: YK
authors.lastname: Yoon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Sohn
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts / Q000469:parasitology; D000818:Animals; D000977:Antiparasitic Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy; D002648:Child; D046148:Donor Selection / Q000379:methods; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007559:Ivermectin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000635:transmission*; D016377:Organ Transplantation / Q000009:adverse effects*; D018570:Risk Assessment; D018805:Sepsis / Q000469:parasitology; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000635:transmission*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin