# P-2110. Strongyloides screening for heart transplant candidates in an endemic region: a single-center experience

## TL;DR

This study reports on the screening of heart transplant candidates in an Appalachian region for Strongyloides infection, finding a 9.5% seroprevalence and successful treatment of all positive cases.

## Contribution

The paper provides the first reported data on Strongyloides screening in heart transplant candidates in the Appalachian region of the U.S.

## Key findings

- Strongyloides seroprevalence was 9.5% among heart transplant candidates in an Appalachian healthcare system.
- All six transplanted patients with positive serology received ivermectin therapy and had no episodes of Strongyloidasis.
- There was no statistically significant association between seropositivity and rural or Appalachian residence.

## Abstract

Strongyloides stercoralis causes chronic intestinal infection and can reactivate in solid-organ transplant (SOT) recipients, leading to severe or fatal outcomes. The American Society of Transplantation (AST) guidelines recommends universal screening strategy in an endemic region. In the United States, the Appalachian region is endemic for Strongyloides, however screening data in SOT recipients has not been reported. We present data from patients undergoing evaluation for heart transplantation at a healthcare system serving a large portion of Appalachia.Table 1Demographics of prospective heart transplant recipients screened for StrongyloidesTable 2Association between residence and Strongyloides seropositivity

Demographics of prospective heart transplant recipients screened for Strongyloides

Association between residence and Strongyloides seropositivity

Between January 2022 and December 2024, patients evaluated for heart transplantation were included. Screening for Strongyloides was performed using an ELISA immunoglobulin G (IgG) assay (ARUP; Salt Lake City, UT). Demographics, region of residence, and designation as rural vs urban region was recorded. Medical charts were reviewed for transplant outcomes.

A total of 311 transplant evaluations were performed in 293 patients, and serology was available for 284 patients. Residence within Appalachia was reported by 88 (31.0%) patients. Overall, 134 (47.2%) patients resided in a rural area, of whom 65 (22.9%) lived in Appalachia (Table 1). Serologic evidence of Strongyloides was found in 27 (9.5%) patients. Rural residents in Appalachia had the highest proportion of positive serology (14.2%), however there was no statistically significant difference compared to the overall cohort (14.2% vs 8.1%, p=0.143), Table 2. There was no significant association between positive serology and rural (9.7% vs 10.0%, p=0.934), or Appalachian residence (11.4% vs 8.7%, p=0.474). Six patients with positive serology were eventually transplanted, and all received therapy with ivermectin. There were no episodes of Strongyloidasis.

Universal screening in an healthcare system serving a region within Appalachia showed 9.5% Strongyloides seroprevalence in heart transplant candidates. The strategy resulted in timely therapy for all transplanted individuals with exposure, and there were no reported instances of Strongyloidasis. While Appalachia is thought to be endemic for Strongyloides, our data raises concern for potential expansion of endemicity, which could be explored with future epidemiologic studies.

All Authors: No reported disclosures