The objective of this study was to assess the long term (10 years) impact of schistosomiasis on patients and graft outcome after renal transplantation.
Methods: This work was conducted by comparing two groups of a total 243 patients: group I consisted of schistosoma infected cases and group II schistosoma-free control cases. Schistosomiasis was documented in group I by identifying schistosoma eggs either in urine, stool or rectal mucosal biopsy, also biopsies from recipient bladder mucosa and lower end ureter of living donors were obtained intraoperatively to search for schistosoma eggs. Schistosomiasis was diagnosed in both recipients and donors in 63 cases, in recipients only in 65 cases, and in donors only in 8 cases.
All schistosoma infected cases (recipients and donors) with active lesions were treated at least one month before transplantation by combined antischistosomal drugs (praziquantel and oxamniquine). The 243 patients (136 schistosoma infected cases and 107 control cases) were followed up regularly for a period of 10 years after transplantation. We found that there was no significant difference in the incidence of acute and chronic rejection between the groups; however, higher cyclosporine doses were needed for the schistosomal group with subsequent higher incidence of both acute and chronic cyclosporine nephrotoxicity. Moreover, the schistosomal group had significantly higher incidence of urinary tract infection and urologic complications with no evidence of schistosomal reinfection. Despite a higher incidence of schistosoma related complications after renal transplantation, schistosomal infection is not a major risk factor for transplantation. Therefore, schistosoma-infected patients can be considered as suitable recipients if they have been properly treated before transplantation.