Microsporidiosis after liver transplantation: A French nationwide retrospective study.

Transplant infectious disease : an official journal of the Transplantation Society 2021 Aug

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Microsporidiosis has been largely reported in patients with acquired immunodeficiency syndrome, but emerged as a cause of persistent diarrhea in solid organ transplant patients. Through the French Microsporidiosis Network and the Groupe français de recherche en greffe de foie, we collected all microsporidiosis cases identified in liver transplant patients between 1995 and 2020 in France. We identified 24 liver transplant recipients with microsporidiosis. Sex ratio was balanced and median age was 58.8 (3.5-83.5) years (there were 4 children). Microsporidiosis occurred at a median time of 3.9 (0.1-18.9) years post-transplant. Median duration of diarrhea before diagnosis was 22 days (12-45). Therapeutic care included immunosuppressive therapy changes in 20 patients, as follows: stop cyclosporine or tacrolimus (n = 2), dose reduction of cyclosporine or tacrolimus (n = 12), stop MMF (n = 5), and dose reduction of corticosteroids (n = 1). In addition, 15 patients received specific therapy against microsporidiosis: fumagillin (n = 11) or albendazole (n = 4). Median duration of treatment was 14 days (8-45 days). Finally, 7 patients had immunosuppressive treatment tapering only. Microsporidiosis was complicated by renal failure in 15 patients, requiring dialysis in one case. Two patients had infection relapse. No patient presented proven rejection within the 3 months after microsporidiosis. None of the patients died within the 3 months after microsporidiosis. Microsporidiosis is a very rare infection after liver transplantation but can induce severe dehydration and renal failure. Therefore, it must be systematically sought in any case of persistent diarrhea after first line screening of frequent infectious causes. © 2021 Wiley Periodicals LLC.

Citation

Jérôme Dumortier, Sylvie Radenne, Nassim Kamar, Filomena Conti, Armand Abergel, Audrey Coilly, Claire Francoz, Pauline Houssel-Debry, Claire Vanlemmens, Noémie Laverdure, Christophe Duvoux, Xavier Iriart, Marc Thellier, Adela Angoulvant, Nicolas Argy, Brice Autier, Anne-Pauline Bellanger, Françoise Botterel, Cyril Garrouste, Meja Rabodonirina, Philippe Poirier, French Microsporidiosis Network. Microsporidiosis after liver transplantation: A French nationwide retrospective study. Transplant infectious disease : an official journal of the Transplantation Society. 2021 Aug;23(4):e13665