Improving Syphilis Screening in Deceased Organ Donors

Theodoropoulos, Nicole; Jaramillo, Andrés; Penugonda, Sudhir; Wasik, C.; Brooks, Katarzyna; Ladner, Daniela P.; Jendrisak, Martin D.; Ison, Michael G.

doi:10.1097/tp.0000000000000323

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…Use of alternative tests or the routine use of confirmatory tests may reduce the frequency of false-positive syphilis results in potential deceased and living organ donors. 314 …”

Section: Rationalementioning

confidence: 99%

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

et al. 2017

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The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109.

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“…Use of alternative tests or the routine use of confirmatory tests may reduce the frequency of false-positive syphilis results in potential deceased and living organ donors. 314 …”

Section: Rationalementioning

confidence: 99%

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

et al. 2017

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“…Such reverse screening approaches are associated with a lower rate of false-positive test results. 51…”

Section: Deceased Donor Evaluation For Infectious Disease Riskmentioning

confidence: 99%

“…In a retrospective study of RPR-positive deceased donors, Theodoropoulos et al demonstrated a false-positive rate of 40.6% for RPR tests. 51 Treponemal-specific tests have greater specificity but continue to yield positive results after successful treatment. 323 The United States Centers for Disease Control specify that a diagnosis of syphilis requires positive results on both a nontreponemal test and a treponemal-specific test.…”

Section: Bacterial Infections In the Deceased Donormentioning

confidence: 99%

“…The conventional approach to screening has been to test first with a nontreponemal test and then confirm positive results with a treponemal-specific test, though more recently there has been a shift to a “reverse-sequence” approach, whereby an initial treponemal-specific test is followed by a nontreponemal test to confirm positive results. 51 Current international guidelines and state-based guidelines in Australia recommend routine screening of deceased donors for syphilis infection using a treponemal-specific EIA, with confirmation by a nontreponemal serological test. If the nontreponemal test is negative, then a second treponemal test based on different antigens to the original test should be performed.…”

Section: Bacterial Infections In the Deceased Donormentioning

confidence: 99%

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Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission

White

Rawlinson

Boan

et al. 2019

Transplantation Direct

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In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.

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“…Use of alternative tests or the routine use of confirmatory tests may reduce the frequency of false-positive syphilis results in potential deceased and living organ donors. 314 As there are multiple available syphilis assays providing different types of information, no single blood assay can conclusively define an individual's disease status. For donor candidate testing, specimen collection and the time available to perform testing must be considered in choosing an appropriate donor screening assay.…”

Section: Syphilismentioning

confidence: 99%

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

Mata

Clayton

Kelly

et al. 2020

Transplantation Direct

View full text Add to dashboard Cite

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.

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Improving Syphilis Screening in Deceased Organ Donors

Abstract: Current screening of deceased organ donors by RPR yields a significant number of false-positive results. Use of alternative tests or the routine use of confirmatory tests may reduce the frequency of false-positive results in deceased organ donors.

Cited by 10 publications

References 18 publications

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

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