Donor-derived infections in solid organ transplant recipients

Abstract

Purpose of review The potential for transmission of donor-derived infections (DDIs) is impossible to eliminate, but a thoughtful and systematic approach to donor evaluation can mitigate the risk. Prevention is a key issue and clinicians must maintain a high index of suspicion and remain vigilant in staying up to date on emerging infections. COVID-19 and Monkeypox have represented a new challenge for infectious disease screening and recommendations have been evolving, as knowledge in the field has grown. Additional considerations for pretransplant deceased donor screening include testing for neglected and endemic infectious diseases such as strongyloidiasis and HTLV 1/2. Molecular diagnostic tests have improved awareness on pathogenicity of mollicutes and fungi in the setting of DDIs. The aim of this review is to provide an update on the most recent literature on DDI with a special focus on these emerging hot topics. Recent findings Donor screening for uncommon pathogens must be guided by knowledge of changing epidemiology of infectious disease and availability of new diagnostic methods. Summary Appropriate screening, early recognition, timely reporting, close monitoring, and appropriate management are essential to help reducing the risk of emerging DDIs.

The value of organ and tissue biovigilance: a cross-sectional analysis

“…The leading cause of SAEs in our study was donor disease without transmission, which is similar to the United Kingdom (40) but differs from other studies describing transcription, procurement, or transport errors as the predominant cause (33,39,41). However, our data are similar to the findings reported (48,49). This study has some limitations.…”

“…( 45 )]; one in four infections were due to virus ( 46 ); approximately one in five were fungal [mainly Candida spp. ( 47 )], and one in seven were caused by parasites, primarily Strongyloides stercoralis ( 48 , 49 ).…”

Skin and soft tissue infections in solid organ transplants

“…Diagnosis is based on PCR on skin lesions swab. Between the two vaccines available, the modified vaccinia Ankara vaccine is indicated in SOT, while the ACAM2000 is contraindicated [69].…”

“…SOT recipients are at an increased risk for hyperinfection syndrome and disseminated disease that manifest with a nonspecific exanthema in about 30% of cases and frequently result in fatal outcomes [89]. The common mechanism of infection in SOT recipients is reactivation of chronic S. stercoralis infection or following immunosuppressive therapy or S. stercoralis DDI infection [69,90]. Two sequential days of ivermectin (200 mg/kg daily) with a second 2 days course 2 weeks later has been observed to be effective for treatment [69,91].…”

“…The common mechanism of infection in SOT recipients is reactivation of chronic S. stercoralis infection or following immunosuppressive therapy or S. stercoralis DDI infection [69,90]. Two sequential days of ivermectin (200 mg/kg daily) with a second 2 days course 2 weeks later has been observed to be effective for treatment [69,91].…”