CDC was notified of Strongyloides infection in transplant recipients of kidneys, pancreas and heart from same deceased donor. Concern for donor-derived strongyloidiasis prompted an investigation to identify causes of transmission, successful treatment options, and future screening measures. We interviewed staff at two transplant centers and Gift of Life. Enzyme immunoassay was conducted on donor and recipient pre-transplant serum for Strongyloides IgG Ab. Donor was a 24 yo Latino man who on nucleic acid testing was negative for HTLV-I. Blood work showed no eosinophilia. He received high dose steroids prior to organ procurement. Heart recipient was a 59 yo Latino man who received high dose steroids for multiple episodes of rejection in addition to tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisone maintenance. He was admitted day 60 post- transplant for respiratory distress. Strongyloides was found in bronchoalveolar lavage and CSF. He failed therapy with ivermectin (IV) and albendazole and succumbed to hyperinfection. Liver recipient died day 2 post-transplant from an arrhythmia. Pancreas-left kidney recipient was a 64 yo Caucasian man who was induced with antithymocyte globulin and methylprednisolone and maintained with TAC, MMF and prednisone. Duodenal biopsy via EGD done day 64 post-transplant for nausea and anorexia demonstrated Strongyloides. Right kidney recipient was a 14 yo boy who was induced with basilixamab and methylprednisolone and maintained with TAC, MMF, and prednisone. Duodenal aspirates on EGD done day 72 post-transplant for fever and diarrhea revealed Strongyloides. Surviving patients were treated with IV and albendazole, as well as, transitioned from TAC to cyclosporine while MMF and prednisone were discontinued. Pediatric patient was treated for T-cell mediated rejection with high-dose steroids and restarted on therapeutic IV. Both patients have cleared Strongyloides ova and parasites and are currently on an IV pulsing regimen. Donor serum revealed the presence of IgG antibodies to Strongyloides at 13.68 units/¯o;l (+ >1.7 units/¯o;l) while recipient pre-transplant serum was negative. Strongyloides screening of all organ donors and recipients from endemic areas is advocated to reduce strongyloidiasis and hyperinfection syndrome in immunocompromised patients. Positive serological tests in potential donors and recipients should prompt early treatment.

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