Transplant Trial Watch

Prophylaxis of human toxoplasmosis: a systematic review.

Rajapakse S, Weeratunga P, et al.

Pathog Glob Health. 2017; 111(7):333-42.

This review aims to describe the modalities for prophylaxis of toxoplasmosis in susceptible populations including transplant recipients.

A search was carried out in PUBMED and EMBASE using broad search terms. The search included all articles published from 1985 to 2017 with no restriction of language. Bibliographies of cited literature were also searched. Three authors systematically assessed the search results and selected manuscripts for inclusion by consensus. There is no assessment of study quality or bias.

1618 papers were identified during the database search and 68 papers were evaluated for relevant data. Data from 42 papers were included in the synthesia (reviews, meta-analyses, randomized controlled trials, observational studies, case control studies and cohort studies). Of these, 29 manuscripts (12570 susceptible patients) included qualitative data on pharmacological prophylaxis for human toxoplasmosis (2 meta-analyses, 9 RCTs and 18 non-RCTs). The majority of studies were from the USA or Europe.

A narrative synthesis of data on prophylaxis for toxiplasmosis. For solid organ tranplantation, data was only available for heart or heart/lung transplant recipients, was drawn from five observational studies and assessed prophylaxis with spiramycin or trimethoprim plus sulphamethoxazole.

Literature published from 1985 to 2017

CET Conclusions
This systematic review has a wide remit, covering the prophylaxis of toxoplasmosis in various at-risk groups (congenital transmission, HIV positive patients and transplant recipients). A broad search was conducted with papers assessed by 3 authors. It is not clear if the protocol was registered in advance. The review included 9 RCTs, 2 meta-analyses and 18 non-randomised studies and no quality assessment of included studies is presented. Most of the information relating to transplantation in this review is in the field of heart transplantation, and these studies are actually very limited in their impact.

Quality notes
Systematic review – QA not appropriate

Trial registration

Funding source
Not reported