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Evaluation of a Geographic Screening Protocol for Chronic Parasitic Infections Before Kidney Transplant: An Institutional Experience in Minnesota
ABSTRACT.
Pretransplant recommendations advise risk-based screening for strongyloidiasis, schistosomiasis, and Chagas disease. We evaluated the implementation of a chronic parasite screening protocol at a health system in a nonendemic region serving a large foreign-born population. Candidates listed for kidney transplant at Hennepin Healthcare (Minneapolis, MN) between 2010 and 2020 were included. Country of birth and serologic screening for strongyloidiasis, schistosomiasis, and Chagas disease were retrospectively obtained from electronic medical records. Parasite screening frequency and seropositivity was assessed before and after implementation of a geographic risk factor–based screening protocol in 2014. Cost-efficiency of presumptive treatment was modeled. Of 907 kidney transplant candidates, 312 (34%) were born in the United States and 232 (26%) outside the United States, with the remainder missing country of birth information. The 447 (49%) candidates evaluated after implementation of the screening protocol had fewer unidentified countries of birth (53%–27%, P < 0.001) and were more frequently screened for strongyloidiasis, schistosomiasis, and Chagas disease (14%–44%, 8%–22%, and 1–14%, respectively, all Ps < 0.001). The number of identified seropositive candidates increased after protocol implementation from two to 14 for strongyloidiasis and from one to 11 for schistosomiasis, with none seropositive for Chagas disease. The cost-efficiency model favored presumptive ivermectin when strongyloidiasis prevalence reaches 30% of those screened. Implementing a geographic risk screening protocol before kidney transplant increases attention to infectious disease risk associated with country of birth and identification of chronic parasitic infections. In populations with higher strongyloidiasis prevalence or lower ivermectin costs, presumptive treatment may be cost-efficient.
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Author Notes
Financial support: This project was supported by a Hennepin Healthcare Department of Medicine Innovation Seed Grant Program. C. T. receives support from the National Institute of Allergy and Infectious Diseases (T32 AI055433).
Authors’ addresses: Christine Thomas, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, E-mail: thom7433@umn.edu. Jessica Butts and Jennifer Czachura, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, E-mails: butts029@umn.edu and czach005@umn.edu. Altair Alonso, School of Medicine, University of Minnesota, Minneapolis, MN, E-mail: alons073@umn.edu. Kevin Reininger, Banner University Medical Center, Phoenix, AZ, E-mail: Kevin.Reininger@Bannerhealth.com. Megan Shaughnessy, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, and Division of Infectious Diseases, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, E-mail: megan.shaughnessy@hcmed.org.