Toxoplasma gondii Serostatus Is Not Associated With Impaired Long-Term Survival after Heart Transplantation

BACKGROUND Conflicting data have been reported about the effect of Toxoplasma serostatus on mortality after heart transplantation. Either a positive or a negative recipient Toxoplasma serostatus was found to be associated with increased mortality. METHODS We evaluated the effects of T. gondii infection on survival of our 582 cardiac allograft recipients operated upon between June 1984 and July 2011. RESULTS The 258 Toxoplasma seronegative and 324 seropositive recipients differed in age, pretransplantation diagnosis, ischemia time, renal function, donor Toxoplasma serology, and maintenance immunosuppression. After a median follow-up time of 8.3 years (range, 0-26 years), 117 (45%) seronegative and 219 (67%) seropositive patients died. No difference was found in deaths due to cardiac allograft vasculopathy. After adjustment for all relevant clinical characteristics, the recipient Toxoplasma serostatus was not associated with mortality (hazard ratio, 1.21; 95% confidence interval [CI], 0.95-1.54). With the Toxoplasma serostatus combination donor negative/recipient negative as a reference, univariate hazard ratios for the Toxoplasma serostatus combinations were D+/R- 0.52 (95% CI, 0.37-0.73), D-/R+ 0.65 (95% CI, 0.40-1.05), and D+/R+ 0.78 (95% CI, 0.57-1.07). Multivariate analysis, however, showed that donor Toxoplasma serostatus was not independently associated with mortality. CONCLUSIONS The Toxoplasma serostatus of both the recipient and donor appeared not to be independent risk factors for mortality after heart transplantation.