High infectious risk organ donors in kidney transplantation: Risks, benefits, and current practices

Approximately 9% of deceased kidney donors are classified by the Centers for Disease Control as high infectious risk donors (HRDs), donors thought to be at increased risk for having HIV infection. While the use of HRDs expands the organ supply, there is a small risk of infectious transmission. All donors are tested for antibodies to a variety of viral infections including HIV, hepatitis C virus (HCV), and hepatitis B virus; however, infections acquired in the weeks to months before death may not be serologically detectable, but will likely be transmitted to the recipient. Nucleic acid testing (NAT) shortens the window between acquisition of infection and serologic detectability, from approximately 22 days to 9 days for HIV and from 66 days to 7 days for HCV. Nucleic acid testing has not been universally adopted because it is expensive, time consuming, and has a higher rate of false positives compared with an enzyme-linked immunosorbent assay (ELISA), which might lead to discarding viable organs. Further studies are needed to quantify the risk of infectious transmission from HRDs, identify patients on the waitlist who would most benefit from HRD receipt, and guide NAT policies.

[1]  L. Kucirka,et al.  Underutilization of Hepatitis C‐Positive Kidneys for Hepatitis C‐Positive Recipients , 2010, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[2]  M. Volk,et al.  Centers for Disease Control ‘High‐Risk’ Donors and Kidney Utilization , 2010, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  D. Asch,et al.  Transplantation of Kidneys from Donors at Increased Risk for Blood‐Borne Viral Infection: Recipient Outcomes and Patterns of Organ Use , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  R. Hasz,et al.  Donor‐Derived Disease Transmission Events in the United States: Data Reviewed by the OPTN/UNOS Disease Transmission Advisory Committee , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[5]  L. Kucirka,et al.  Provider Utilization of High‐Risk Donor Organs and Nucleic Acid Testing: Results of Two National Surveys , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[6]  L. Kucirka,et al.  Formal Policies and Special Informed Consent Are Associated with Higher Provider Utilization of CDC High‐Risk Donor Organs , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[7]  L. Kucirka,et al.  Viral Nucleic Acid Testing (NAT) and OPO‐Level Disposition of High‐Risk Donor Organs , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  D. Segev,et al.  Renal transplant in HIV-positive patients: long-term outcomes and risk factors for graft loss. , 2009, Archives of surgery.

[9]  R. Freeman,et al.  Transplantation Risks and the Real World: What Does ‘High Risk’ Really Mean? , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[10]  Joseph C. Ahn,et al.  Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation , 2008, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[11]  L. Kucirka,et al.  The high-risk donor: viral infections in solid organ transplantation. , 2008, Current opinion in organ transplantation.

[12]  R. Hasz,et al.  Informing candidates for solid-organ transplantation about donor risk factors. , 2008, The New England journal of medicine.

[13]  D. Stablein,et al.  HIV‐Infected Liver and Kidney Transplant Recipients: 1‐ and 3‐Year Outcomes , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  E. Perencevich,et al.  Estimated Benefits of Transplantation of Kidneys from Donors at Increased Risk for HIV or Hepatitis C Infection , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[15]  P. Stock,et al.  Solid organ transplantation is a reality for patients with HIV infection , 2006, Current HIV/AIDS reports.

[16]  S. Kleinman,et al.  Assessing the impact of HBV NAT on window period reduction and residual risk. , 2006, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[17]  G. Moraleda,et al.  De Novo HBV Infection Caused by an Anti‐HBc Positive Donor in a Vaccinated Liver Transplant Recipient In Spite of Anti‐HBs Response , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[18]  F. Mozzi,et al.  Risk of transmission of hepatitis B virus from anti-HBC positive cadaveric organ donors: a collaborative study. , 2005, Transplantation proceedings.

[19]  M. Schnitzler,et al.  The Impact of Transplantation with Deceased Donor Hepatitis C‐Positive Kidneys on Survival in Wait‐Listed Long‐term Dialysis Patients , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[20]  A. Fluit,et al.  False-Positive Results and Contamination in Nucleic Acid Amplification Assays: Suggestions for a Prevent and Destroy Strategy , 2004, European Journal of Clinical Microbiology and Infectious Diseases.

[21]  G. Schreiber,et al.  Comparative sensitivity of HBV NATs and HBsAg assays for detection of acute HBV infection , 2003, Transfusion.

[22]  L. Agodoa,et al.  Donor hepatitis C seropositivity: clinical correlates and effect on early graft and patient survival in adult cadaveric kidney transplantation. , 2002, Journal of the American Society of Nephrology : JASN.

[23]  L. Mimms,et al.  Significant Closure of the Human Immunodeficiency Virus Type 1 and Hepatitis C Virus Preseroconversion Detection Windows with a Transcription-Mediated-Amplification-Driven Assay , 2002, Journal of Clinical Microbiology.

[24]  P. Pfau,et al.  Hepatitis C transmission and infection by orthotopic heart transplantation. , 2000, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[25]  A. Angelini,et al.  HIV infection in the first heart transplantation in Italy: fatal outcome , 1998, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[26]  R. Wiesner,et al.  The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient. , 1997, Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[27]  G. Snell,et al.  Multi-organ donor transmission of hepatitis C virus to five solid organ transplant recipients and lack of transmission to corneal transplant recipients. , 1995, Clinical and diagnostic virology.

[28]  G. Satten,et al.  Time course of detection of viral and serologic markers preceding human immunodeficiency virus type 1 seroconversion: implications for screening of blood and tissue donors , 1995, Transfusion.

[29]  R. Moseley,et al.  Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs , 1994 .

[30]  L. Ferrell,et al.  "Occult" hepatitis B virus as source of infection in liver transplant recipients , 1994, The Lancet.

[31]  A. Levey,et al.  Transmission of hepatitis C virus by organ transplantation. , 1991, The New England journal of medicine.

[32]  L. Kucirka,et al.  Provider response to a rare but highly publicized transmission of HIV through solid organ transplantation. , 2011, Archives of surgery.

[33]  R. Suri ABO-Incompatible Heart Transplantation in Infants: Analysis of the United Network for Organ Sharing Database , 2009 .