Asymptomatic transmission of Treponema pallidum (syphilis) through deceased donor liver transplantation

Abstract

A 55-year-old woman underwent liver transplantation (LT) with a graft from a deceased donor. Mandatory pre-donation investigations showed positive syphilis serology that was available only after the transplant, with high Treponema pallidum particle agglutination assay titer compatible with donor syphilis infection. Despite the institution of appropriate post-exposure prophylaxis, the recipient demonstrated latent seroconversion; however, liver graft function improved without evidence of syphilitic hepatitis or other manifestations of the disease. Through this first reported case of asymptomatic transmission of syphilis following LT, we highlight the investigations and treatment strategies for donor-derived syphilis in liver transplant recipients. This report supplements the existing limited evidence on safe use of infected grafts from syphilitic donors through appropriate post-exposure prophylaxis.

Syphilis transmission: a review of the current evidence

“…10 Other case reports describe the likely transmission of syphilis after transfusion of fresh blood products that had negative syphilis serological assays at the time of transfusion. 9,34 More recently, reports of outcomes among recipients of syphilis-positive organ donors have been published, 35–37 and seroconversion has been documented following liver transplantation from an infected deceased donor despite the administration of post-exposure prophylaxis in the recipient. 37 The organ recipient remained asymptomatic, and syphilis infection in the donor is not considered a contraindication to solid organ transplantation.…”

“…9,34 More recently, reports of outcomes among recipients of syphilis-positive organ donors have been published, 35–37 and seroconversion has been documented following liver transplantation from an infected deceased donor despite the administration of post-exposure prophylaxis in the recipient. 37 The organ recipient remained asymptomatic, and syphilis infection in the donor is not considered a contraindication to solid organ transplantation. 37 Occupational exposure to syphilis via accidental injury with a scalpel has been described and is another potential mode of transmission via blood.…”

“…37 The organ recipient remained asymptomatic, and syphilis infection in the donor is not considered a contraindication to solid organ transplantation. 37 Occupational exposure to syphilis via accidental injury with a scalpel has been described and is another potential mode of transmission via blood. 38 …”

Nonspecific Immunoglobulin Replacement in Lung Transplantation Recipients With Hypogammaglobulinemia

“…1 Syphilis has rarely been transmitted via organ transplantation, with one confirmed transmission reported to the Organ Procurement and Transplantation Network (OPTN) between 2005 and 2009 and two cases in the published literature. [2][3][4][5] There are also cases of transplantation of syphilis-positive organs where there was no transmission to the recipients after appropriate therapy. [6][7][8][9] Current policy requires that all deceased organ donors be screened for syphilis infection using a Food and Drug Administration (FDA)-cleared screening or diagnostic test (Table S1, SDC, http://links.lww.com/TP/B28).…”

Changing Pattern of Donor Selection Criteria in Deceased Donor Liver Transplant: A Review of Literature

“…Severe systemic bacterial sepsis concomitant with abnormal liver function are an unfavorable combination, whereas other bacterial diseases, though rare, carry a risk of transmission and the resulting infection may also have implications on graft function (e.g., toxoplasmosis, syphilis). 62 These grafts may be used with caution with appropriate post exposure antibiotic prophylaxis or treatment in the recipient.…”