Volume 23, Number 7—July 2017
Dispatch
Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain
Nerea Carrasco-Antón
, Francisco López-Medrano, Mario Fernández-Ruiz, Eugenia Carrillo, Javier Moreno, Ana García-Reyne, Ana Pérez-Ayala, María Luisa Rodríguez-Ferrero, Carlos Lumbreras, Rafael San-Juan, Jorge Alvar, and José María Aguado
, Francisco López-Medrano, Mario Fernández-Ruiz, Eugenia Carrillo, Javier Moreno, Ana García-Reyne, Ana Pérez-Ayala, María Luisa Rodríguez-Ferrero, Carlos Lumbreras, Rafael San-Juan, Jorge Alvar, and José María Aguado
Table 1
Baseline and clinical characteristics of solid organ transplant recipients in study of risk factors for VL, Madrid, Spain, January 1, 2005–January 1, 2013*
| Characteristics | Overall cohort, n = 68 | VL, n = 7 | No VL, n = 61 | p value† |
|---|---|---|---|---|
| Recipient age, y, mean ± SD | 51.1 ± 14.2 | 53.0 ± 15.5 | 51.0 ± 13.5 | 0.721 |
| Male sex, no. (%) |
48 (70.6) |
6 (85.7) |
42 (68.9) |
0.664 |
| Race, no. (%) | ||||
| White | 62 (91.2) | 5 (71.4) | 57 (93.4) | 0.112 |
| Black, sub-Saharan African | 4 (5.9) | 2 (28.6)‡ | 2 (3.3) | 0.049 |
| Other |
2 (2.9) |
0 (0) |
2 (3.3) |
1.000 |
| Type of SOT, no. (%) | ||||
| Kidney | 57 (83.8) | 6 (85.7) | 51 (83.6) | 1.000 |
| Liver | 8 (11.8) | 0 (0) | 8 (13.1) | 0.587 |
| Heart |
3 (4.4) |
1 (14.3) |
2 (3.3) |
0.282 |
| Donor age, y, mean ± SD | 46.1 ± 16.2 | 49.4 ± 17.4 | 46.3 ± 16.3 | 0.596 |
| Cold ischemia time, min, median (IQR) | 1,005 (630–1,354) | 795 (371–1,365) | 1,020 (660–1,360) | 0.370 |
| No. HLA mismatches, mean ± SD | 4.0 ± 1.2 | 5.0 ± 1.0 | 4.0 ± 1.2 | 0.265 |
| DCD donor, no. (%) | 18 (26.5) | 3 (42.8) | 15 (24.6) | 0.370 |
| Transplant during the outbreak, no. (%) |
41 (60.3) |
7 (100.0) |
34 (55.7) |
0.037 |
| Induction therapy, no. (%) | ||||
| Basiliximab | 22 (32.4) | 0 (0) | 22 (36.1) | 0.087 |
| Antithymocyte globulin | 24 (35.3) | 4 (57.1) | 20 (32.8) | 0.233 |
| None |
22 (32.4) |
3 (42.8) |
19 (31.1) |
0.673 |
| Maintenance immunosuppression, no. (%) | ||||
| Steroids | 56 (82.4) | 7 (100.0) | 49 (80.3) | 0.338 |
| Calcineurin inhibitors | 60 (88.2) | 6 (85.7) | 54 (88.5) | 1.000 |
| Mycophenolate mofetil/mycophenolic acid | 47 (61.8) | 4 (57.1) | 43 (70.5) | 0.668 |
| mTOR inhibitors |
10 (14.7) |
1 (14.3) |
9 (14.8) |
1.000 |
| Complications in the first year after SOT, no. (%) | ||||
| Acute graft rejection | 19 (27.9) | 2 (28.6) | 17 (27.9) | 1.000 |
| CMV infection | 21 (30.9) | 4 (57.1) | 17 (27.9) | 0.189 |
| Bacterial infection |
60 (88.2) |
6 (85.7) |
54 (88.5) |
0.190 |
| Environmental factors | ||||
| Frequent contact with dogs, no. (%) | 26 (38.2) | 3 (42.8) | 23 (37.7) | 1.000 |
| Habit of visiting the park, no. (%)§ | 19 (31.7) | 3 (50.0) | 16 (29.6) | 0.369 |
| Distance from patient’s residence to park, m, median (IQR) | 1,220 (849–1,865) | 399 (261–985) | 1,370 (974–1,880) | 0.001 |
*CMV, cytomegalovirus; DCD, donation after circulatory death; HLA, human leukocyte antigen; IQR, interquartile range; mTOR, mammalian target of rapamycin; SOT, solid organ transplant; VL, visceral leishmaniasis.
†The p values refer to the comparison between patients with and without visceral leishmaniasis. Significant values are in bold.
‡The country of birth of both patients with posttransplant VL was Equatorial Guinea.
§Data available for 60 patients.
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Page updated: June 19, 2017
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