Schistosoma Mansoni Infection and Liver Graft

A 23-year-old male diagnosed with posthepatitis B cirrhosis underwent an orthotopic liver transplant in June 2002. This patient had suffered from oesophageal variceal bleeding in March 2001, was treated by endoscopic ligature, and had undergone lamivudine treatment since December 2001. He was classified Child Pugh B8. The donor was a 59-year-old man who had died from intracerebral hemorrhage. The patient's biological hepatic tests were normal, as was his liver ultrasound.

At the end of the transplant procedure, a hepatic biopsy of the graft was performed. Histological examination showed two granulomas surrounding eggs of Schistosoma. Two 2-day treatments of praziquantel (Biltricide) were administered as specific antischistosomal treatment on the second and third postoperative days and 2 weeks later for another 2 days. The postoperative course was uneventful with a moderate rejection on day 21 which was easily treated with an increase of tacrolimus. Six months after the liver transplant, the patient developed HHV-8 primary infection and underwent several liver biopsies none of which showed Schistosoma eggs or liver fibrosis. Schistosomiasis is a parasitic disease which causes liver fibrosis. Eggs trapped in the liver parenchyma induce granuloma and inflammation that can lead to periportal fibrosis and portal hypertension. Liver fibrosis can be prevented by early administration of antischistosomal drugs (¹).

To our knowledge this is the first reported case of a liver transplant with a graft infected by Schistosoma Mansoni. Impact of Schistosomiasis on graft outcomes after kidney transplants have been reported and it has been shown that there was no significant incidence of acute or chronic rejection, provided that the patients are treated using antischistosomal drugs 1 month before the transplant procedure (²). In our case, treatment of the recipient with praziquantel efficiently prevented any consequence of this incidental Schistosomiasis of the liver graft. Such treatment was not considered as a contraindication to the use of praziquantel considering the absence of associated liver fibrosis.

Virginie Pannegeon

Jean-Pierre Masini

François Paye

Department of Digestive Surgery and

Intensive Care

Hôpital Saint Antoine

Paris, France

Olivier Chazouillères

Department of Hepatology

Hôpital Saint Antoine

Paris, France

Pierre Marie Girard

Department of Infectious Disease

Hôpital Saint Antoine

Paris, France