All liver, lung and kidney transplant patients receive Pneumocystis jirovecii pneumonia (PJP) prophylaxis (co-trimoxazole p.o. 1x daily 480 mg for 3-6 months) which also provides protection against reactivation of toxoplasmosis. If co-trimoxazole prophylaxis is not possible (due to toxicity / allergy), then, given the low incidence, no alternative Toxoplasma prophylaxis is indicated (1).
Prophylaxis
First choice
co-trimoxazole 1x daily 960 mg po
Second choice
dapsone 1x daily 50 mg po* + pyrimethamine once weekly 50 mg + folinic acid once weekly 25 mg
atovaquone 1x daily 1500 mg po
*Exclude G6PD deficiency when using dapsone due to risk of haemolytic anaemia
Indications:
start criteria: positive T. gondii serology (IgG) and CD4<100/mm3
stop criteria: CD4>100/mm3 >3 months
Prophylaxis