Dengue Virus Transmission from Living Donor to Recipient in Liver Transplantation: A Case Report

Abstract

Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver transplantation is a rare entity, and currently, there is no recommendation for screening this virus prior to transplantation. We report a case of transmission of dengue virus from donor to recipient after liver transplantation. The recipient had a history of multiple admissions for hepatic encephalopathy and ascites. He was admitted in the ICU for 15 days for chronic liver disease, ascites, and acute kidney injury before transplantation. The donor was admitted 1 day before transplantation. The donor spiked fever on postoperative day 2 followed by thrombocytopenia and elevated liver enzymes. The donor blood test was positive for dengue NS1 antigen. The recipient also had a similar clinical picture on postoperative day 5 and his blood test was also positive for dengue NS1 antigen. Hence, the diagnosis for posttransplant donorderived allograft-related transmission of dengue infection was made. Both recipient and donor were treated with supportive measures and discharged after their full recovery on postoperative days 9 and 18, respectively. The effect of immunosuppression on dengue presentation is still unclear and there is lack of literature available. In our case, the recipient developed dengue fever similar to general population without showing any feature of severe graft dysfunction. We have concluded that dengue virus can also be transmitted from donor to recipient, and immunosuppression did not have any adverse effect on the evolution of dengue fever within the recipient. Delhi being a hyperendemic zone, screening for donors (especially in season time) for dengue virus seems to be the best preventive method to control donor-derived transmission of dengue to recipient. ( J CLIN EXP HEPATOL 2016;6:59-61) T he epidemiology of dengue, an endemic disease, has been changing rapidly in Delhi. Transmission of dengue virus from donor to recipient is rarely reported. Currently, there is no recommendation for screening this virus prior to transplantation. We describe a case of transmission of dengue virus from donor to recipient after liver transplantation. CASEA 40-year-old man presented with cryptogenic liver disease (since 2013). He was admitted with features suggestive of decompensated chronic liver disease with ascites (no SBP), AKI, and hepatic encephalopathy. He had history of multiple admissions in the past with a diagnosis of hepatic encephalopathy. In view of recurrent hepatic encephalopathy and decompensated chronic liver disease with child class C (13/15) MELD score of 26, the patient was advised for liver transplantation. The donor was his 29-year-old brother-in-law, who was admitted 1 day prior to transplant. He was evaluated as per protocol. After stabilization of recipient (15th day of his admission), he underwent living donor liver transplantation, which was uneventful.The donor spiked fever of 103 8F on POD 3 and continued to have fever for t...

Confirmed Transmission of Bacterial or Fungal Infection to Kidney Transplant Recipients from Donated After Cardiac Death (DCD) Donors in China: A Single-Center Analysis

“…This apparent discrepancy might be due to inadequate sample size. Furthermore, in some centers, cases that are associated with less severe disease (e.g., transient bacteremia that responds quickly to therapy) are likely to be under-recognized and, therefore under-reporting may be significant [ 27 ]. Furthermore, a thorough review of cultures for all kidney recipients of organs from DCD donors has now been implemented at our institute.…”

Imported Arbovirus Infections in Spain, 2009–2018

“…According to published data, CHIKV in solid organ transplant recipients seems to have a benign course and favorable outcome (19,20), whereas data for DENV in these patients are less clear. Case descriptions report uncomplicated outcomes, whereas a recent literature review reported a significantly higher incidence of severe dengue and a higher mortality rate among transplant patients with dengue (21)(22)(23). A recent report of DENV, ZIKV, and CHIKV infections diagnosed in hematopoietic stem cell transplant recipients and oncohematologic patients found prolonged viremia in those with DENV and viruria in those with ZIKV; the most common complication was thrombocytopenia, but all patients survived without sequelae (24).…”

Dengue Virus Infection in Solid Organ Transplant Recipients: A Case Series and Literature Review

“…It is presumed that dengue diagnosis among SOT recipients could be difficult because of the immunosuppressive regimen that may mask dengue symptoms. 17,26 In addition, the symptoms can be attributed to comorbidities, opportunistic infections, or the adverse effects of some immunosuppressive drugs, 27,28 all of which can delay dengue diagnosis with the subsequent deterioration of patient outcomes. Thus, in regions where the virus is endemic, dengue should be suspected early in SOT recipients and opportunely evaluated by infectious diseases specialist and a timely critical care unit access should be assured.…”