HEPATIC SCHISTOSOMIASIS FOUND IN EXPLANTED LIVER POST-TRANSPLANT H. Alrowais MD 1 , O. Nnedu 2 1 Department of Medicine, Ochsner Clinic Medical Center, New Orleans, LA 2 Department of Medicine, Section of Infectious Disease, Ochsner Medical Center, New Orleans, LA INTRODUCTION: About 779 million individuals are at risk for Schistosomiasis. Due to travel and immigration, about 400,000 or more people with Schistosoma infection may live in the United States. Schistosomiasis can present acutely with nocturnal fever, myalgia, headache, and abdominal pain. Chronic infection develops over time, from an initial granulomatous inflammatory response to Schistosome eggs progressing to fibrosis. The initial host response is a delayed hypersensitivity with modest Th1 response, which is followed by a dominant Th2 mediated response producing inflammatory cytokines leading to granuloma formation. CASE: A 57-year-old Saudi Arabian man with ESRD secondary to membranous nephropathy (unsuccessfully treated with tacrolimus) was referred for a combined kidney and liver transplantation. Shortly after starting dialysis, he was diagnosed with NASH cirrhosis and referred for infectious disease pre-transplant consultation. He had anasarca, abdominal distension, and crackles at the lung bases. Serology was positive for CMV IgG, Strongyloides and Schistosoma IgG and seronegative for HAV, HBV, HCV andHIV. Hewas prescribed praziquantel for Schistosoma and ivermectin for Strongyloides before transplant. Pathologic evaluation of the explanted liver showed helminthes and ova consistent with the adult Schistosomiasis). The patient underwent a successful liver and kidney transplant but he passed away due to post-operative complications. DISCUSSION: The impact of tacrolimus on host immune response to parasite eggs is unclear. Tacrolimus has been shown to inhibit differentiation of T-cells to Th1 and Th2 subsets. In theory, use of tacrolimus would decrease host immune responses to the Schistosoma eggs thereby decreasing pathology. Early studies showed that adult Schistosoma parasite possess a Tacrolimus binding protein. Subsequent studies however showed that Tacrolimus had no in vivo or in vitro effect on adult parasite growth suggesting that Tacrolimus binding protein in Schistosoma species does not play a significant role in parasite survival. There is limited published data on solid organ transplantation and Schistosomiasis. Two observational studies showed no survival difference between transplant recipients with Schistosomiasis and those without. There have been three published cases of recurrent hepatic Schistosomiasis following liver transplantation but this didn’t lead to graft loss. Using organs harvested from individuals with Schistosomiasis did not affect transplant survival in these cases.
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