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Toxoplasma Prophylaxis Post-Transplant — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostToxoplasma Prophylaxis Post-TransplantSCE Infectious Diseases

A 45-year-old man undergoes living-donor kidney transplant. Pre-transplant serology shows donor Toxoplasma IgG positive, recipient Toxoplasma IgG negative (D+/R-). What prophylaxis should be considered?

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Correct answer: A — Co-trimoxazole prophylaxis (which covers both PJP and Toxoplasma) for at least the first 6 months post-transplant

In D+/R- Toxoplasma mismatch, particularly in heart transplant (highest risk due to cyst persistence in cardiac muscle) but also in kidney transplant, prophylaxis against Toxoplasma should be provided. Co-trimoxazole (used for PJP prophylaxis) also provides effective Toxoplasma prophylaxis at standard PJP doses. This dual benefit makes Co-trimoxazole the ideal agent. Duration should be at least 6 months post-transplant (longer if ongoing high-dose immunosuppression). Toxoplasma seroconversion can cause disseminated disease in seronegative recipients.

Reference: NICE NG37 2016 – Solid organ transplant; BTS 2024 – Post-transplant infections