Transmission of hepatitis C virus through transplanted organs and tissue--Kentucky and Massachusetts, 2011

On September 29, 2011, the United Network for Organ Sharing notified CDC of two patients who tested positive for hepatitis C virus (HCV) infection approximately 6 months after receiving kidney transplants from a deceased donor. Before transplantation, the donor had tested negative for HCV antibody by the organ procurement organization. Tissue also was procured from the donor for possible transplantation. The tissue bank performed an HCV antibody test on the donor's serum specimen that was negative and nucleic acid testing (NAT) that was positive, but misread as negative. Retesting of the donor specimen during the investigation confirmed the NAT results as positive. Donated tissue included 43 musculoskeletal grafts and one cardiopulmonary patch, which were distributed to health-care facilities in several states. An investigation was initiated to 1) identify potential sources of the donor's infection, 2) document the mode of transmission to the organ recipients, and 3) ensure timely notification of the implanting surgeons and testing of tissue recipients. Implantation of infected HCV tissue occurred after recognition of new HCV infection in the organ transplant recipients, highlighting the need for rapid communication between transplant centers, organ procurement organizations, tissue banks, and public health authorities regarding suspected transplantation transmission events.     

Transplantation-transmitted tuberculosis--Oklahoma and Texas, 2007

Approximately 28,000 organ transplants were performed in the United States in 2007. When infections are transmitted from donors, the implications can be serious for multiple recipients. Tuberculosis (TB), a known infectious disease complication associated with organ transplantation, occurs in an estimated 0.35%-6.5% of organ recipients in the United States and Europe posttransplantation. In 2007, the Oklahoma State Department of Health identified Mycobacterium tuberculosis in an organ donor 3 weeks after the donor's death. This report summarizes results of the subsequent investigation, which determined that disseminated TB occurred in two of three transplant recipients from this donor, and one recipient died. Genotypes of the donor and recipient TB isolates were identical, consistent with transmission of TB by organ transplantation. To reduce the risk for TB transmission associated with organ transplantation, organ recovery personnel should consider risk factors for TB when assessing all potential donors. In addition, clinicians should recognize that transplant recipients with TB might have unusual signs or symptoms. When transmission is suspected, investigation of potential donor-transmitted TB requires rapid communication among physicians, transplant centers, organ procurement organizations (OPOs), and public health authorities.     

Brief report: Lymphocytic choriomeningitis virus transmitted through solid organ transplantation--Massachusetts, 2008

Lymphocytic choriomeningitis virus (LCMV) is a rodent-borne arenavirus found worldwide. House mice (Mus musculus) are the natural reservoir, but LCMV also can infect other wild, pet, and laboratory rodents (e.g., rats, mice, guinea pigs, and hamsters). Humans can be infected through exposure to rodent excreta. Person-to-person transmission has occurred only through maternal-fetal transmission and solid organ transplantation. LCMV infection in humans can be asymptomatic or cause a spectrum of illness ranging from isolated fever to meningitis and encephalitis. Overall case fatality is <1%. Fetal infections can result in congenital abnormalities or death. Immunosuppressed patients, such as organ transplant recipients, can develop fatal hemorrhagic fever-like disease. Transmission of LCMV and an LCMV-like arenavirus via organ transplantation has been documented in three previous clusters. Of 11 recipients described in those clusters, 10 died of multisystem organ failure, with LCMV-associated hepatitis as a prominent feature. The surviving patient was treated with ribavirin (an antiviral with in vitro activity against LCMV) and reduction of immunosuppressive therapy. On April 15, 2008, an organ procurement organization (OPO) notified CDC of severe illness in two kidney transplant recipients from a common donor; at the time of notification, one of the recipients had died. Samples from the donor and both recipients were tested at CDC; on April 22, test results revealed evidence of acute LCMV infection in the donor and both recipients. This report summarizes the results of the subsequent public health investigation.     

Update: investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004

On July 1, 2004, CDC reported laboratory confirmation of rabies as the cause of encephalitis in an organ donor and three organ recipients at Baylor University Medical Center (BUMC) in Dallas, Texas. Hospital and public health officials in Alabama, Arkansas, Oklahoma, and Texas initiated public health investigations to identify donor and recipient contacts, assess exposure risks, and provide rabies postexposure prophylaxis (PEP). As of July 9, PEP had been initiated in approximately 174 (19%) of 916 persons who had been assessed for exposures to the organ recipients or the donor. As a result of its public health investigation, the Arkansas Department of Health determined that the donor had reported being bitten by a bat (Frank Wilson, M.D., Arkansas Department of Health, personal communication, 2004).     

Potential transmission of viral hepatitis through use of stored blood vessels as conduits in organ transplantation--Pennsylvania, 2009

Solid organ transplantation sometimes requires the use of blood vessels from a deceased donor as conduits to connect transplanted organ vessels to recipient vessels. Vessels not immediately used are sometimes stored for later use, including vessels collected from hepatitis B virus (HBV) and hepatitis C virus (HCV) seropositive donors; HBV and HCV seropositive vessels can be stored for use in seropositive recipients. In May 2009, HCV was transmitted when a transplant facility inadvertently used a blood vessel conduit from an HCV-seropositive donor in a seronegative recipient. In November 2009, a second transplant facility, the University of Pittsburgh Medical Center (UPMC), identified two cases of potential hepatitis virus transmission from vessel conduits. In December 2009, CDC was asked to assist the local health department in conducting an investigation at UPMC. This report summarizes the results of that investigation, which determined that, although neither recipient of the vessel conduits at UPMC contracted hepatitis, these represented "near miss" incidents in which transmission could have occurred. The storage of vessels from hepatitis-seropositive donors at UPMC and its affiliated Department of Veterans Affairs (VA) hospital was not necessary; vessels from seropositive donors were infrequently used because adequate supplies of vessels from seronegative donors were available. UPMC's prohibition of the storage of vessels from hepatitis-seropositive donors has removed a documented risk factor for viral transmission while not substantially affecting the transplant centers' vessel conduit supply. Evaluation of available national data supports this prohibition. Therefore, CDC recommends that transplant centers discontinue the practice of storing vessel from donors with markers for viral hepatitis, including HBV surface antigen (HBsAg), HCV antibody (anti-HCV), and HBV or HCV detectable by nucleic acid tests.     

West Nile virus infection in organ donor and transplant recipients--Georgia and Florida, 2002

On August 23, 2002, the Georgia Division of Public Health (GDPH) and CDC were notified of two cases of unexplained fever and encephalitis in recipients of organ transplants from a common donor. An investigation has identified illness in two other recipients from the same donor: one with encephalopathy and the other with febrile illness. CDC, the Food and Drug Administration, GDPH, and the Florida Department of Health are conducting the investigation. This duster could possibly represent the first recognized transmission of West Nile virus (WNV) by organ donation.     

Notes from the field: transplant-transmitted hepatitis B virus --- United States, 2010

On March 29, 2011, CDC was notified about a possible transplant-associated hepatitis B virus (HBV) infection in a liver transplant recipient with no known risk factors for HBV infection. An investigation was begun to learn if other recipients of organs or tissues from the donor had been infected with HBV and to investigate potential sources of the donor's infection.     

Update: interim guidance for minimizing risk for human lymphocytic choriomeningitis virus infection associated with pet rodents

In May 2005, CDC received reports of illness in four solid-organ transplant recipients who were later determined to have been infected with lymphocytic choriomeningitis virus (LCMV) from a common organ donor. Three of the four organ recipients died, 23-27 days after transplantation. This report updates information about the ongoing investigation and provides interim measures for reducing the risk for LCMV infection from pet rodents associated with this outbreak.     

Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach--United States, September 2006

On September 13, 2006, CDC officials were alerted by epidemiologists in Wisconsin and Oregon that fresh spinach was the suspected source of small clusters of Escherichia coli serotype O157:H7 infections in those states. On the same day, New Mexico epidemiologists contacted Wisconsin and Oregon epidemiologists about a cluster of E. coli O157:H7 infections in New Mexico associated with fresh spinach consumption. Wisconsin public health officials had first reported a cluster of E. coli O157:H7 infections to CDC on September 8. On September 12, CDC PulseNet had confirmed that the E. coli O157:H7 strains from infected patients in Wisconsin had matching pulsed-field gel electrophoresis (PFGE) patterns and identified the same pattern in patient isolates from other states. This report describes the joint investigation and outbreak-control measures undertaken by state public health officials, CDC, and the Food and Drug Administration (FDA). This investigation and additional case finding are ongoing.     

Investigation of blood transfusion recipients with West Nile virus infections

An investigation conducted by CDC, the Food and Drug Administration (FDA), the American Red Cross, and state health departments in Georgia and Florida has confirmed transmission of West Nile virus (WNV) from a single organ donor to four organ recipients. During treatment for injuries that eventually proved fatal, the organ donor received numerous transfusions of blood products. However, the source of the organ donor's infection remains unknown.     

Organ donation agency: A discourse analysis of correspondence between donor and organ recipient families

Studies about the psychosocial issues concerning organ donation and transplantation tend to focus on the experiences of donor or recipient families. Little is known about the part played by correspondence exchanged between these two groups; in particular how they perceive the agency of organ donation. This is the first analysis to address the representation of the act of donation from the viewpoint of both donor and recipient families through interrogation of archived correspondence data, using linguistic techniques. The data was drawn from a collection of letters, from four USA organ procurement organisations, exchanged between donor and transplant recipient families. Donor families consistently linguistically ascribed agency and accountability for donation to the person who died, the donor. For the recipient families, on the other hand, the ‘giver’ was mainly implied, ambiguous or ascribed to the donor family.     

Encephalitis Caused by Pathogens Transmitted through Organ Transplants,United States, 2002–2013

The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. During 2002–2013, the US Centers for Disease Control and Prevention investigated several encephalitis clusters among transplant recipients. Cases were caused by infections from transplant-transmitted pathogens: West Nile virus, rabies virus, lymphocytic choriomeningitis virus, and Balamuthia mandrillaris amebae. In many of the clusters, identification of the cause was complicated by delayed diagnosis due to the rarity of the disease, geographic distance separating transplant recipients, and lack of prompt recognition and reporting systems. Establishment of surveillance systems to detect illness among organ recipients, including communication among transplant center physicians, organ procurement organizations, and public health authorities, may enable the rapid discovery and investigation of infectious encephalitis clusters. These transplant-transmitted pathogen clusters highlight the need for greater awareness among clinicians, pathologists, and public health workers, of emerging infectious agents causing encephalitis among organ recipients.     

Investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004

On June 30, 2004, CDC confirmed diagnoses of rabies in three recipients of transplanted organs and in their common donor, who was found subsequently to have serologic evidence of rabies infection. The transplant recipients had encephalitis of unknown etiology after transplantation and subsequently died. Specimens were sent to CDC for diagnostic evaluation. This report provides a brief summary of the ongoing investigation and information on exposure risks and postexposure measures.     

Contraceptive use among solid organ transplant patients: a systematic review

Background

Women undergoing solid organ transplantation are advised to avoid pregnancy for up to 24 months following transplant surgery.

Study Design

We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women having undergone solid organ transplantation.

Results

From 643 articles, eight articles from seven studies satisfied review inclusion criteria; six articles pertained to kidney transplant patients, and two reported on liver transplant patients. Two reports of one prospective cohort of 36 kidney transplant recipients taking combined oral contraceptives (COCs) or using the transdermal contraceptive patch reported no significant changes in biochemical measures after 18 months of use for either group, although 13 women modified antihypertensive medication, and two women discontinued the study because of serious medical complications. Four case reports of five kidney recipients using intrauterine devices reported inconsistent findings, including both beneficial health effects and contraceptive failures. One retrospective, noncomparative study of 15 liver transplant recipients using COCs or the transdermal contraceptive patch found no significant changes in any biochemical measures obtained, no discontinuations or severe complications and no pregnancies after a 12-month follow up. One case report of a liver transplant recipient on cyclosporine and prednisone documented the development of cholestasis associated with high-dose (50 mcg ethinyl estradiol) COC use as treatment for heavy uterine bleeding.

Conclusions

Very limited evidence on COC and transdermal contraceptive patch use among kidney and liver transplant recipients indicated no pregnancies and no overall changes in biochemical measures. Excluding case reports, evidence on other contraceptive methods or contraception among other types of solid organ transplants was not identified.     

Hepatitis C virus transmission from an antibody-negative organ and tissue donor--United States, 2000-2002

In June 2002, a physician reported to the Oregon Department of Human Services (DHS) a case of acute hepatitis C in a patient who had received a patellar tendon with bone allograft from a donor approximately 6 weeks before onset of illness. At the time of the donor's death in October 2000, his serum had no detectable antibody to hepatitis C virus (anti-HCV). The ensuing investigation conducted by CDC and DHS confirmed that the donor, although anti-HCV-negative, was HCV RNA-positive and the probable source of HCV infection for at least eight organ and tissue recipients. This report summarizes the preliminary results of the investigation. Although transmission from anti-HCV-negative tissue donors probably is rare, determining the frequency of transplantations from such donors and the risk for transmitting HCV to recipients is important in evaluating whether additional prevention measures are warranted.     

Lymphocytic choriomeningitis virus infection in organ transplant recipients--Massachusetts, Rhode Island, 2005

On May 3, 2005, CDC received a report of severe illness in four patients who had received solid organ transplants from a common donor. All four organ recipients subsequently were found to have evidence of infection with lymphocytic choriomeningitis virus (LCMV), a rodent-borne Old World arenavirus. Preliminary findings from the ensuing investigation indicate the source of infection likely was an infected hamster in the donor's home. This report summarizes the ongoing investigation and provides information on exposure risks and possible prevention measures.     

Update: Investigations of West Nile virus infections in recipients of organ transplantation and blood transfusion

An investigation involving CDC, the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), the Georgia Division of Public Health, and the Florida Department of Health identified West Nile virus (WNV)-associated illnesses in four recipients of organs from the same donor. Although the transplanted organs were the source of infection for the four organ recipients, the source of the organ donor's infection remains unknown; an investigation of the numerous transfusions received by the organ donor is ongoing.     

Procuring organs for transplantation -- a European perspective

Background: The shortage of organs for transplant In Europehas been considerable for many years. A number of differentpolicies have been implemented in an attempt to address thisproblem. These have had varying degrees of success from countryto country. Methods: This article provides an up-to-date reviewof organ procurement policies throughout Europe. Alternativeand In some cases controversial organ procurement programmesare also considered to establish whether the increasing demandfor organs can be met elsewhere. Results: Transplant waitinglists are the greatest by far for those patients waiting fora kidney replacement. Norway has best managed to address thisneed through adopting a positive policy choice towards livedonation whilst still maintaining an active cadaveric donationpolicy. Conclusion: With the lowering of both physical and socialbarriers In Europe, there has been a recent shift towards co-operationbetween some European countries in promoting transplant activity.This ensures that if an organ becomes available in one countryand has no suitable recipient, then it can be used elsewhere.The future may show and increasing trend towards this levelof European cooperation in order to make transplant activitymore efficient.     

Patterns of volunteerism, testing, and exclusion among potential living kidney donors

We found that in kidney transplantation, more females donate. We analyzed transplant recipients for patterns of potential donor exclusion and found that equal proportions of male and female potential donors existed among first-degree biological relatives. More male recipients were married and therefore had more spousal potential donors. Among friends and non-first-degree relatives, significantly fewer males offered to donate to females. Equal proportions of female and male potential donors were excluded from donating for medical comorbidities, blood type incompatibility, recipient refusal, and potential donor reluctance. We concluded that female transplant candidates had fewer potential donors among spouses and opposite sex volunteers from friends and non-first-degree relatives.     

SARS-CoV-2 Infections among Recent Organ Recipients,March–May 2020, United States

We conducted public health investigations of 8 organ transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 infection. Findings suggest the most likely source of transmission was community or healthcare exposure, not the organ donor. Transplant centers should educate transplant candidates and recipients about infection prevention recommendations.