Record number:
1049
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare
Time to detection:
5 days
Alerting signals, symptoms, evidence of occurrence:
Recipient developed fever on postoperative day 5 after living-related renal transplantation in a dengue-endemic region (Singapore). The patient's blood was tested for dengue virus (DENV) using Real Time PCR and was positive for DENV serotype 1. Recipient developed severe dengue with prolonged thrombocytopenia (12 days) , leukopenia, GI bleed with haemoperitoneum and shock. Treated supportively and recoverd.
Demonstration of imputability or root cause:
The donor (recipient's mother) had a history of dengue fever 6 months prior to donation. Authors do not mention if diagnosis in donor was confirmed 6 months prior to donation and it is not known whether donor organs remain infected after apparent resolution of viraemia. No serology performed in donor/recipient. Temporal relation between transplant and onset of symptoms in recipients. Authors mention that there was no active transmission in the area at the time, making infection acquired during his admission, unlikely. Timeline not decribed, hence other routes of infection (for example, asymptomatic or subclinical infection in the recipient prior to transplant) cannot be excluded. DENV-1 was the predominant type during the major outbreak in 2005 in Singapore before the serotype switch to DENV-2.
Imputability grade:
1 Possible
Groups audience:
Keywords:
Reference attachment:
Suggest references:
Tan FL, Loh DL, Prabhakaran K, Tambyah PA, Yap HK. Dengue haemorrhagic fever after living donor renal transplantation. Nephrol Dial Transplant. 2005 Feb;20(2):447-8.
Expert comments for publication:
Despite the common occurrence of dengue infection, there have been very few case reports on donor-derived transmission. Due to paucity of data and the fact that these cases have been described in endemic areas, imputability has been “probable” at most. Different to the rare cases of fatal complications of dengue infection acquired in the post transplantation period (not donor-related), the 4 existing publications report good outcome in the recipients. Insufficient data exist about potential virus compartmentalisation after disappearance in blood and dengue outcomes in immunosuppressed individuals. In non-endemic areas, individual risk assessment is the option of choice when exposure to dengue or other relevant arbovruses is identified.