Toxoplasmosis in Transplant Recipients

Europe, 2010-2014

Florence Robert-Gangneux; Valeria Meroni; Damien Dupont; Françoise Botterel; José M. Aguado Garcia; Marie-Pierre Brenier-Pinchart; Isabelle Accoceberry; Hamdi Akan; Isabella Abbate; Katia Boggian; Fabrizio Bruschi; Jordi Carratalà; Miruna David; Lubos Drgona; Olgica Djurković-Djaković; Maria Carmen Farinas; Francesca Genco; Effrossyni Gkrania-Klotsas; Andreas H. Groll; Edward Guy; Cédric Hirzel; Nina Khanna; Özgür Kurt; Lia Monica Junie; Tiziana Lazzarotto; Oscar Len; Nicolas J. Mueller; Patricia Munoz; Zoi Dorothea Pana; Emmanuel Roilides; Tijana Stajner; Christian van Delden; Isabelle Villena; Hervé Pelloux; Oriol Manuel


Emerging Infectious Diseases. 2018;24(8):1497-1504. 

In This Article


Participating Centers

We recruited applicants through 2 study groups of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID; the European Study Group on Clinical Parasitology and the European Study Group on Immunocompromised Hosts) and through the Spanish Transplantation Infection Study Group, the Italian Society of Clinical Microbiology Infections and Transplant Working Group, and the Swiss Transplant Cohort Study. For each country, a local coordinator was identified and was in charge of contacting investigators from transplantation or infectious diseases units from representative centers.

Data Collection

Participants were invited to answer a detailed questionnaire adapted to the type of graft and designed to collect the following information: Toxoplasma seroprevalence in the country (documented by articles or recent surveys); implementation of a case reporting system for toxoplasmosis in transplant recipients; annual number of transplant procedures for each organ type in the participating center and in the whole country; pretransplant serologic screening policy for recipients and donors; implementation of recipient monitoring after transplantation and methods used (PCR, serology); and chemoprophylaxis regimen and duration according to organ type (if cotrimoxazole was given primarily for preventing Pneumocystis pneumonia, this use was recorded) and according to the recipient serologic results (primary or secondary prophylaxis, whether chemoprophylaxis was given to seronegative recipients, seropositive recipients, or both). When official national guidelines were lacking, to obtain representative data, we collected information about local practices in several transplant centers whenever possible.

As a second step, we sent an electronic case reporting form to all voluntary participating centers, which retrospectively recorded the number of cases of toxoplasmosis diagnosed per center over a 5-year period (2010–2014). The form collected the following information: patient age and sex; date of transplantation and type of graft; Toxoplasma serologic status of recipient and donor; date of toxoplasmosis diagnosis; site of infection (cerebral, ocular, disseminated); tools contributing to diagnosis (serology, molecular diagnosis, pathology, direct examination, imaging); chemoprophylaxis type, date of initiation, and duration; patient survival at 2 and 6 months; and date of death, if applicable. From each center and for each organ type, we also collected the mean patient age and the mean percentage of the whole transplant patient population surviving at 2 months and at 6 months. The number of cases and clinical data were retrieved from hospital medical or laboratory databases or from local or national databases, if existing. Participants were invited to send only aggregated data generated automatically by the database. The study was approved by the Ethics Committee of the University Hospital of Rennes, France (approval no. 15.12).

Statistical Analyses

Descriptive statistics are expressed as frequency (percentage) or mean ± SE. Comparison of qualitative data between groups was based on exact χ 2 tests for equal proportions or Fisher exact tests if single table values were <5; quantitative data were compared by using analysis of variance or t-test (nonparametric test). We computed data by using SAS software version 9.4 (SAS Institute, Cary, NC, USA).