Introduction: Strongyloidiasis stercoralis is an intestinal parasite that affects 30-100 million people worldwide. Immunosuppressed organ transplant recipients are at high risk of Strongyloides hyperinfection syndrome where increased larval proliferation leads to sepsis, multi-organ failure and death. Outside of regions where the parasite is endemic, however, national guidelines generally only recommend screening deceased organ donors when certain risk factors are present. However, detection of Strongyloides infections among deceased organ donors with no identifiable risk factors and unclear aetiology is increasing. Therefore, we report the seroprevalence of Strongyloides in deceased organ donors within New South Wales, Australia and determine the extent to which risk factors for Strongyloides infection as listed in the TSANZ Clinical Guidelines for Organ Transplantation from Deceased Donors predict seropositivity in this population.

Method: We retrospectively screened all planned deceased organ donors in NSW for Strongyloides IgG seropositivity between January 2021 to April 2023. For each positive case identified, we searched the Electronic Donor Record for the presence of risk factors for Strongyloides infection as listed in the TSANZ Clinical Guidelines for Organ Transplantation from Deceased Donors. We report the relationship between the presence of individual risk factors with Strongyloides seropositivity and report the percentage of seropositive cases who did not exhibit any identifiable risk factor.

Results: 304 planned deceased organ donors were retrospectively screened for Strongyloides. 17 ( 5.6%) returned positive serology, 10 (58.8%) of whom had no identifiable risk factors. Individual risk factors identified in positive cases are shown in Figure 1. 

Conclusion: In countries with diverse, multi-ethnic and immigrant populations, targeted screening of potential organ donors may not identify all cases of chronic Strongyloides infection. Clinicians should consider screening all donors for Strongyloides, regardless of individual risk factors.