A 5-year single-center review of Strongyloides seropositivity in kidney transplant candidates in Central Texas.

Abstract

Introduction: Strongyloides stercoralis is a soil-transmitted helminth that can lead to life-threatening hyperinfection in transplant recipients. Targeted screening based on social history alone may preclude a large proportion of seropositive patients. Our institution implemented universal screening for kidney transplant candidates. This study aimed to identify the prevalence and identify risk factors of transplant candidates.

Methods: This was a retrospective chart review of kidney transplant candidates who were Strongyloides seropositive using the Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) test. An equivocal Strongyloides serology was defined as 1.0 to 1.1 IV, a positive test as >1.1 IV, and a negative test as <1.0 IV.

Results: A total of 1653 patients underwent screening for Strongyloides, and 121 (7.3%) tested positive. Forty-seven patients (38.8%) who tested positive had no reported travel history to endemic areas, and 86% of patients originated from the United States. Forty-six patients (97.9%) who received a kidney transplant received treatment with ivermectin, and none developed disseminated disease or hyperinfection.

Conclusions: Among kidney transplant candidates screened for Strongyloides, 7.3% were seropositive and many reported no travel history to endemic areas, which highlights the significant prevalence of this parasite in Central Texas. Universal screening at our institution identified a substantial number of seropositive patients who might have otherwise been missed.