Utilization of increased risk for transmission of infectious disease donor organs in solid organ transplantation: Retrospective analysis of disease transmission and safety |
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Authors: | Linda Irwin Camille N Kotton Nahel Elias Julie Palafox Debra Basler Sarah H Shao William Lester Xiaofeng Zhang Brendan Kimball Carrie Trencher Jay A Fishman |
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Institution: | 1. MGH Transplant Center, Massachusetts General Hospital, Boston, MA, USA;2. Transplant Infectious Disease and Compromised Host Program, Massachusetts General Hospital, Boston, MA, USA;3. Harvard Medical School, Boston, MA, USA;4. Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA;5. Pulmonary Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA;6. Laboratory of Computer Sciences, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA |
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Abstract: | The inadequate supply of transplantable organs necessitates new approaches to organ availability. Serologies and nucleic acid testing (NAT) for hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) are used in microbiologic screening of potential organ donors. Organs from donors considered at “high risk” (Centers for Disease Control and Prevention, CDC 1994) or “increased risk” (U.S. Public Health Service, PHS 2013) for transmission of viral infection to recipients may provide an expanded source of organs for transplantation. We review a single‐center experience with 257 adult organ recipients of organs from donors meeting either CDC 1994 or PHS 2013 risk criteria between 2011 and 2016. Tracking these transplants required modification of the Transplant Center electronic database to identify all recipients of increased‐risk donor (IRD) organs, documentation of informed consent, and microbiologic testing data. No transmissions of HIV, HBV, or HCV were identified by NAT or clinically. Nine patients developed positive serologic assays for one of the tested viruses; all recipients were retested and remain negative by NAT. Notably, post‐transplant HBV core serologies reverted to negative on re‐testing; these positive serologies are likely false positives caused by receipt of blood products. Use of IRD organs can be performed safely with appropriate informed consent and rigorous pre‐ and post‐transplant microbiological testing. |
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Keywords: | donor‐derived infection hepatitis B virus hepatitis C virus HIV increased risk nucleic acid testing serologic assays |
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