Screening for Zika virus in deceased organ donors in Florida

Abstract

Zika virus (ZIKV) cases have been detected across the United States (US) and locally acquired cases have been reported in Florida. Currently, there are no ZIKV screening guidelines and no data on the incidence among organ donors in the US. This retrospective study was conducted at Jackson Memorial-Miami Transplant Institute. Positive ZIKV tests in local deceased organ donors were investigated from 6/2016 to 1/2017. We evaluated demographics and risk factors for ZIKV infection among organ donors and transplant outcomes among recipients of donors with positive ZIKV testing. One hundred forty-two donors were analyzed. Ten percent had traveled to ZIKV-endemic countries and 19% had outdoor occupations. Only 3% had positive ZIKV IGG. None had a positive ZIKV IGM or PCR. ZIKV-positive donors were more likely to have traveled to ZIKV-endemic countries (50% vs. 9%, P = .05). The kidneys from a ZIKV-positive donor were transplanted in our hospital with no 6-month rejection, graft failure, or death in the recipients. Our study demonstrated a low prevalence of ZIKV among deceased donors in our community. Despite local ZIKV transmission, ZIKV was more common in donors who traveled to ZIKV-endemic countries. This cohort demonstrated excellent outcomes in recipients of ZIKV IGG-positive donors. However, larger studies are needed.

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

“…Non-bacterial meningoencephalitis has been reported to transmit a variety of infections, 42,49 and it is recommended by the Ad Hoc Disease Transmission Advisory Committee of UNOS that extreme caution be used in determining the suitability of donors with meningoencephalitis of unknown etiology or because of a pathogen without available treatment. 50…”

Review of the impact of donor characteristics on pediatric heart transplant outcomes

“…However, transmission of West Nile virus from donor to recipients has been reported to cause neuroinvasive disease in up to 70% of recipients and death in 30% . Although donor‐derived infection has not yet been reported in the literature for Zika virus, a survey of donors from an endemic area indicates that 3% were positive for Zika IgG but none were positive by PCR testing …”

“…Donors presenting with non‐bacterial meningoencephalitis have been reported to transmit a variety of infections in solid organ transplant recipients not previously covered in prior sections including but not limited to Rabies and Balamuthia mandrillaris yy . It is recommended by the Ad Hoc Disease Transmission Advisory Committee of the United Network for Organ Sharing in the United States that donors with meningoencephalitis due to a pathogen without available treatment that extreme caution be used in determining the suitability of the donor based on the events reported to this committee (https://optn.transplant.hrsa.gov/resources/guidance/guidance-for-recognizing-central-nervous-system-infections-in-potential-deceased-organ-donors/).…”

Arbovirus in Transplants of Solid Organs and Eyeball:high Risk in Endemic Area Receptors?/ Arbovírus Em Transplantes De Órgãos Sólidos E Globo Ocular:alto Risco Em Receptores De Área Endêmica?

“…Studies in a population with liver and kidney transplantation, that had vectorial infection, years after transplantation, showed the course of infection similar to patients who received the contaminated organs and, non-transplanted patients without any organ involvement or deaths, due to critical complications [18,19,23,24]. The above statement suggests that the prolonged use of immunosuppressants, does not favor the immunopathogenesis of the infection and, that in this case, the drug has only a protective effect.…”