Toxoplasma gondii primary
infection/reactivation after solid
organ transplantation is a serious complication, due to the high mortality rate following disseminated disease. We performed a retrospective study of all cases of T. gondii
infections in 436 adult patients who had received an orthotopic cardiac transplant at our Institution from May 1968 to January 2011. Six patients (1.3%) developed T. gondii
infection/reactivation in the post-operative period. All
infections/reactivations occurred before 1996, when no standardized
toxoplasmosis prophylactic regimen or
co-trimoxazole prophylaxis was used. Starting with the 112th heart transplant, oral
pyrimethamine 75 mg/day was used for seronegative transplant recipients whose donors were seropositive or unknown. Two patients (33.3%) presented with disseminated
toxoplasmosis infection, and all patients (100%) had
myocarditis. Five patients (83.3%) were seronegative before transplant and one patient did not have pre-transplant serology available. Median time for
infection onset was 131 days following
transplantation. Three patients (50%) died due to
toxoplasmosis infection. After 1996, we did not observe any additional cases of T. gondii
infection/reactivation. In conclusion,
toxoplasmosis in heart allographs was more frequent among seronegative heart recipients, and oral
pyrimethamine was highly effective for the prevention of T. gondii
infection in this population.