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.