Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years' follow-up

Background. Schistosomiasis is a major health problem in some areas of the world. Schistosomal-specific nephropathy is a well-known occurrence and eve ntually leads to end-stage renal failure. Patients with schistosomal infect ion were considered to be suitable recipients for renal transplantation. Ho wever, the long-term impact of schistosomiasis on kidney transplantation is not yet been reported. Methods. The long-term impact of schistosomiasis on patient and graft outco mes was studied by comparing two groups of subjects from a total of 243 pat ients. Group I consisted of cases with schistosomal infections and group It consisted of schistosoma-free controls. Schistosomiasis was documented in group I by identifying schistosoma eggs in urine, stool or rectal mucosal b iopsy. Also intra-operative biopsies from bladder mucosa of the graft recip ients and from the lower end of the ureter of living donors were obtained t o search for schistosoma eggs. Results. Sixty-three cases of schistosomiasis were diagnosed in both recipi ents and donors, 65 cases in recipients only, and eight cases in donors onl y. Infected recipients and donors with active lesions were treated at least I month before transplantation by combined antischistosomal drugs (praziqu antel and oxamniquine). The 243 patients (136 schistosoma-infected cases an d 107 controls) were followed regularly for a period of 10 years after tran splantation. We found that there was no significant difference in the incid ence of acute and chronic rejection between the groups; however, higher cyc losporin doses were needed for the infected group with subsequent higher in cidence of both acute and chronic cyclosporin nephrotoxicity. Moreover, the schistosomal group had a significantly higher incidence of urinary tract i nfection and urological complications with no evidence of schistosomal re-i nfection. Conclusions. Despite a higher incidence of schistosoma-related complication s after renal transplantation, schistosomal infection is not a major risk f actor for transplantation. Therefore, infected patients can be considered a s suitable recipients if they have been properly treated before transplanta tion.