Transplantation of contaminated organs

Abstract

In cadaveric organ transplantation there is a risk of transfer of infectious agents from donor to recipient. The consequences can be fatal for immunosuppressed recipients. This is illustrated by a case history in which an infection with the fungus Monosporium apiospermum was transferred from a donor to two cadaveric kidney recipients, of whom one died and the other survived with the loss of the graft. These events led to a review of the literature to determine methods of demonstrating possible contamination of donor organs. Analysis of the case history of potential donors, a history taken from relatives or the family doctor, autopsy and laboratory examinations are considered useful. Victims of drowning, patients with severe burns and patients who have been ventilated for a long time are high risk donors.

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

“…Primary hepatic mucormycosis occurred only in liver transplant recipients and renal mucormycosis manifested as acute rejection in four kidney transplant recipients (109). Donors who are near-drowning victims may acquire unusual moulds from contaminated water such as Apohysomyces elegans (an agent of mucormycosis) and Scedosporium apiospermum, which may be transmitted with the organs (110,111). In both instances, the donors had a febrile illness with pulmonary infiltrates.…”

Invasive Fungal Infections in Solid Organ Transplant Recipients

“…Transplanted organs may act as reservoirs for potentially pathogenic fungi. Transmission of an array of pathogenic fungi including Aspergillus species , Candida species, Histoplasma capsulatum , Cryptococcus neoformans , Coccidioides immitis and Scedosporium apiospermum has been reported [6–19]. Active fungal disease in the donor is a contraindication to transplantation, but infection may be latent and unknown to the donor and transplant team.…”

Donor-Related Coccidioidomycosis in Organ Transplant Recipients

“…CMV [10,11], hepatitis B virus [12,13], and HIV [14][15][16] may be transmitted from donors to SOTRs. Although it is less common, the transmission of fungi, including Histoplasma capsulatum [17], Aspergillus fumigatus [18], Candida albicans [19], Scedosporium apiospermum [20], and Cryptococcus neoformans [21,22], to SOTRs has been well documented. Donor-related transmission of C. immitis to SOTRs was convincingly demonstrated only recently in a lung transplant recipient with fulminant pneumonia [7].…”