Donor-Derived Infections: Monitoring of Posttransplant Infections and Safety Lessons From the Opioid Epidemic.

Objectives: The inadequate supply of transplantable organs necessitates new approaches to donor screening while avoiding transmission of infections. Donor-derived infections are well described. Multiple changes have occurred in donor management and organ utilization, including increased recognition of and therapies for viral infections, the emergence of multidrug antimicrobial-resistant organisms, and identification of some uncommon viral infections transmitted with allografts to clusters of recipients. Donor evaluation has been impacted by substance use-associated deaths and routine use of serologies and nucleic acid testing for hepatitis C virus, hepatitis B virus, and human immunodeficiency virus. Improved assays are needed to prevent infectious transmissions.

Materials And Methods: The MGH Transplant Center reviewed experience with recipients of organs from donors meeting donor risk criteria and tracked all recipients for possible exposures to hepatitis C virus, hepatitis B virus, and human immunodeficiency virus. This required development of an electronic database to document microbiologic testing data.

Results: Database enhancements allowed tracking of serologic testing. Among our organ recipients, no transmissions of the studied viruses were identified by nucleic acid testing or clinically. Multiple patients had positive serologic assays for tested viruses; all recipients were retested, and appropriate interventions were introduced if the test was confirmed. Some false-positive serologies resulted from recent hepatitis B virus vaccination, receipt of blood products, or transmission of donor B cells with tissues.

Conclusions: Organ transplant from donors meeting donor risk criteria for disease transmission can be performed safely with appropriate informed consent and rigorous pre- and posttransplant microbiological testing. Enhanced compliance with vaccination for hepatitis B virus should be tracked. New sequencing technologies developed for investigation of undiagnosed infections and in xenotransplantation may inform future directions for donor screening. Such tools may increase the safe utilization of organs from donors who have potential risk for transmission of infection to recipients.