Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case-control study.


Journal Article

Visceral leishmaniasis (VL) is a rare disease in solid-organ transplant (SOT) recipients. Therefore, little is known about the risk factors and disease behavior in the transplant setting. This multicenter, matched case-control study (1:2 ratio) was designed to determine the risk factors, clinical features and outcomes of VL among this population. Control and case subjects were matched by center, transplant type and timing. Thirty-six VL cases were identified among 25 139 SOT recipients (0.1%). VL occurred 5.7-fold more frequently in Brazil than in Spain, presenting a median time of 11 months after transplantation. High-dose prednisone in the preceding 6 months was associated with VL. Patients were diagnosed over 1 month after symptom onset in 25% of cases. Thirty-one patients (86%) were febrile upon diagnosis, 81% exhibited visceromegaly and 47% showed pancytopenia. Concomitant infection was common. Parasites were identified in 89% of patients; the remaining patients were diagnosed by serology. The majority of the patients received amphotericin B. Relapses occurred in 25.7% of cases, and the crude mortality rate was 2.8%. VL after SOT is related to the VL prevalence in the general population. Delayed diagnosis frequently occurs. Liposomal amphotericin is the most commonly used therapy; mortality is low, although relapses are common.

Full Text

Cited Authors

  • Clemente, W; Vidal, E; Girão, E; Ramos, ASD; Govedic, F; Merino, E; Muñoz, P; Sabé, N; Cervera, C; Cota, GF; Cordero, E; Mena, A; Montejo, M; López-Medrano, F; Aguado, JM; Fernandes, P; Valerio, M; Carratalá, J; Moreno, A; Oliveira, J; Mourão, PHO; Torre-Cisneros, J

Published Date

  • January 2015

Published In

Volume / Issue

  • 21 / 1

Start / End Page

  • 89 - 95

PubMed ID

  • 25636932

Pubmed Central ID

  • 25636932

Electronic International Standard Serial Number (EISSN)

  • 1469-0691

International Standard Serial Number (ISSN)

  • 1198-743X

Digital Object Identifier (DOI)

  • 10.1016/j.cmi.2014.09.002


  • eng