INFECTIOUS COMPLICATIONS IN TRANSPLANTATION: Edited by Shimon KusneToxoplasmosis in the non-orthotopic heart transplant recipient population, how common is it? Any indication for prophylaxis?Dhakal, Reshikaa; Gajurel, Kiranb; Montoya, Jose G.cAuthor Information aDepartment of Medicine, Carver College of Medicine bDivision of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa cDivision of Infectious Diseases and Geographic Medicine, Stanford University, School of Medicine, Toxoplasma Serology Laboratory, National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California, USA Correspondence to Jose G. Montoya, MD, Division of Infectious Diseases and Geographic Medicine, Stanford University, School of Medicine, Toxoplasma Serology Laboratory, National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, CA, USA. E-mail: [email protected] Current Opinion in Organ Transplantation: August 2018 - Volume 23 - Issue 4 - p 407-416 doi: 10.1097/MOT.0000000000000550 Buy Metrics Abstract Purpose of review Unlike in orthotopic heart transplant (OHT) setting where toxoplasma prophylaxis is a standard practice in pretransplant toxoplasma seronegative recipients who have received donor hearts from seropositive donors (D+/R-), there is no consensus regarding prophylaxis in non-OHT recipients. Recent findings The incidence of toxoplasma disease in non-OHT recipients is less than 1% but its true burden is underestimated. Among 31 cases of toxoplasma disease reported from 2004 through 2017, renal and liver transplant recipients comprised of 90% of cases. A total of 94% of 18 recipients with known pretransplant serology were seronegative recipients (mostly D+/R-). Out of 16 recipients with adequate information, 10 (63%) and five (31%) were deemed to be donor derived and nondonor-derived primary toxoplasmosis respectively. Tissue invasive reactivation was uncommon. Almost all cases were described in patients not on prophylaxis at the time of presentation. Universal screening of donor/recipient toxoplasma serology for risk stratification is beneficial as illustrated by reports of fatal cases of toxoplasmosis due to unavailability of positive donor serology results. Summary Toxoplasma disease in non-OHT predominantly occurs in pretransplant seronegative recipients- mostly in D+/R- group and is rare in seropositive recipients. Posttransplant prophylaxis should be targeted against the high-risk D+/R- group and should be considered in seropositive recipients in whom unusually high immunosuppression is implemented. Toxoplasma serologies and PCR should be used in combination for the diagnosis of toxoplasmosis in non-OHT patients. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.