Cotrimoxazol prophylaxis during the first six weeks after transplantation is generally recommended in sero-negative transplanted patients receiving organs from sero-positive donors, especially those receiving heart or heart/lung transplants. This approach has led to a significant decline of clinical toxoplasmosis.
Toxoplasma infection in liver-, kidney-, or bone marrow-transplanted patients is unusual. The incidence of Toxoplasma infection in Sweden is below 1% in these groups of patients. Normally we do not perform Toxoplasma serology assessments, with the exception of heart and lung/heart donors and recipients. It is worth noting that all patients receive low-dose cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia during the first six months after transplantation, which may also have a prophylactic effect against Toxoplasma. A general recommendation to transplanted patients is that they should avoid eating raw flesh. In addition, contact with cats should be avoided due to the fact that they are the major reservoir of toxoplasmosis. The risk of being infected with Toxoplasma declines after the transplantation. Maximal immunosuppressive therapy is in general given during the first 1-3 months after the transplantation. Thereafter the immunosuppression is reduced to significantly lower levels.
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