Visceral Leishmaniasis After Kidney Transplant: An Unusual Presentation and Mode of Diagnosis

Visceral leishmaniasis in kidney transplant recipients and candidates: an integrative review of the last 20 years

INTRODUCTION

Leishmaniasis is a potential concern for solid organ transplant (SOT) recipients, particularly those from endemic regions. Among SOT procedures, kidney transplantation (KT) is the most common. This study aims to synthesize the evidence about visceral leishmaniasis (VL) in KT candidates and recipients, with a focus on risk factors and associated outcomes.

METHODS

This integrative review analyzed studies from the past 20 years, focusing on disease profile, treatment, prognosis, and risk of asymptomatic infection.

RESULTS

A total of 32 articles were included. Of the KT recipients, 85.7% were male, with an average age of 42.5 years. The average timespan since symptom onset was 54.7 months. Renal function impairment was reported in 64% of patients, with an associated mortality rate of 15%. Post-treatment relapse occurred in 10-37.5% of patients. Among KT candidates, 13.9% were seropositive for Leishmania spp.

CONCLUSION

VL is an infrequent condition among KT recipients, limiting the quality of the available evidence. Early detection and prompt treatment are crucial for improving outcomes. While renal function impairment is common, it rarely leads to graft rejection. In the reviewed studies, the coexistence of VL and cutaneous or mucocutaneous forms was linked to higher mortality. Recurrences are common and require individualized management strategies. Hemotransfusion poses a potential infection risk, although routine screening in blood banks is not yet recommended.

Serosurvey of Visceral Leishmaniasis in Organ Transplant Recipients in the South of Iran

BACKGROUND

Visceral leishmaniasis (VL) can become active and cause specific problems in transplant recipients. The current study was conducted with the aim of serological evaluation of VL in transplant patients in a comprehensive transplantation center in Fars province southern Iran.

METHODS

The study population included 150 organ transplant recipients. Blood sample was taken from each patient and the sera were evaluated for anti-Leishmania antibodies by an ELISA method. While sampling from patients, the required information was recorded in a questionnaire and finally analyzed by SPSS software.

RESULTS

Out of the 150 recruited patients, 96 (64%) were men and 54 (36%) were women. The youngest participant was 18 years old and the oldest was 85, with an average age of 46.24 (±15.13). Among the participants, 79 (52.66%) had undergone kidney transplantation, 69 (46%) liver transplantation, 1 (0.66%) intestinal transplantation, and 1 (0.66%) had undergone SPK (kidney and pancreas) transplantation. The participants were from various provinces of Iran, with the majority (61.33%) residing in Fars province. Anti-Leishmania antibodies were detected in the sera of 4 individuals (2.7%) among the study population. The overall seroprevalence of VL did not have a statistically significant association with variables such as gender, age, type of transplant, transplant rejection, or place of residence (P > 0.05).

CONCLUSION

The results of the current study indicate a noticeable seroprevalence of VL in transplant patients in southern Iran. Given the potential risk of reactivation of VL in transplant patients, the need for greater attention to its prevention, timely diagnosis, and treatment becomes more obvious.

South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors

These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .

Epidemiology, Clinical Characteristics, Diagnostic Work Up, and Treatment Options of Leishmania Infection in Kidney Transplant Recipients: A Systematic Review

Current knowledge on Leishmania infection after kidney transplantation (KT) is limited. In order to offer a comprehensive guide for the management of post-transplant Leishmaniasis, we performed a systematic review following the latest PRISMA Checklist and using PubMed, Scopus, and Embase as databases. No time restrictions were applied, including all English-edited articles on Leishmaniasis in KT recipients. Selected items were assessed for methodological quality using a modified Newcastle-Ottawa Scale. Given the nature and quality of the studies (case reports and retrospective uncontrolled case series), data could not be meta-analyzed. A descriptive summary was therefore provided. Eventually, we selected 70 studies, describing a total of 159 cases of Leishmaniasis. Most of the patients were adult, male, and Caucasian. Furthermore, they were frequently living or travelling to endemic regions. The onset of the disease was variable, but more often in the late transplant course. The clinical features were basically similar to those reported in the general population. However, a generalized delay in diagnosis and treatment could be detected. Bone marrow aspiration was the preferred diagnostic modality. The main treatment options included pentavalent antimonial and liposomal amphotericin B, both showing mixed results. Overall, the outcomes appeared as concerning, with several patients dying or losing their transplant.