Donor-derived infection—the challenge for transplant safety

Abstract

Organ transplantation, including of the heart, lung, kidney, liver, pancreas, and small bowel, is considered the therapy of choice for end-stage organ failure. Each year, over 70,000 organs are implanted worldwide. One donor may provide multiple organs, as well as corneas and other tissues, for multiple recipients. The degree of risk for transmission of infection carried with grafts, notably of viruses, is largely unknown and, for a specific organ, difficult to assess. The approach to microbiological screening of organ donors varies with national and regional regulations and with the availability and performance of microbiological assays used for potential donors. Transmission of both expected or common, and unexpected infections has been observed in organ transplants, generally recognized after development of clusters of infections among recipients of organs from a common donor. Other than for unusual or catastrophic events, few data exist that define the incidence and manifestations of donor-derived infections or the ideal assays to use in screening to prevent such transmissions. Absolute prevention of the transmission of donor-derived infections in organ transplantation is not possible. However, improvements in screening technologies will enhance the safety of transplantation in the future.

Pacientų Gyvybinių Veiklų Vertinimas Ir Komplikacijų Prevencijos Būdai Ankstyvuoju Periodu Po Inksto Transplantacijos

“…Jas paprastai sukelia nozokomialiniai organizmai (rezistentiškos gramneigiamos bacilos, auksinis stafilokokas, Candida) dėl sisteminės donoro infekcijos ar užterštumo organo priežiūros metu. Aišku, iš donoro gali būti perduota anksčiau nenustatyta kita infekcija -tuberkuliozė, histoplazmozė, kitos -kurios taip pat gali manifestuoti ir ankstyvajame pooperaciniame periode [17]. Kai kurie autoriai teigia, kad infekuotų donorų organus taip pat galima panaudoti [18].…”

Brucellosis in Immunocompromised Hosts

“…Currently, SOT that includes transplantation of kidney, lung, heart, liver, pancreas and small bowel is the treatment of choice for many end-stage diseases [104,113]. Since the first successful kidney transplantation in 1954, SOT has increased worldwide as currently more than 70,000 SOTs are performed annually [113,114].…”

“…The approach to screening of organ donors varies according to the: (1) national and regional regulations, (2) availability of certain microbiological assays or tests in the transplantation center, and (3) epidemiology of infections in the region, particularly endemic infections such as brucellosis [113]. The infections that can be transmitted by SOT are included in Table 1, [104,105,[114][115][116][117].…”

“…Since the first successful kidney transplantation in 1954, SOT has increased worldwide as currently more than 70,000 SOTs are performed annually [113,114].…”

“…Health education and provision of printed material are essential in the prevention strategies of infections [115]. Absolute prevention of the transmission of donor-derived infections in SOT is not possible, but improvement in screening technologies will enhance the safety of SOT in the future [113]. Future advances will likely include: (1) the utilization of rapid molecular diagnostic procedures particularly for fastidious organisms such as Brucella species, and (2) possibly, additional testing for newly emerging pathogens such as Swine Flu virus (H1N1) and Corona virus infections [115].…”