Status:
Ready to upload
Record number:
2015
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Dependent on endemnicity of region, but even in areas of high endemnicity the frequency has not been quantified, and thus would consider this a rare event.
Time to detection:
Five to nine days after liver transplant
Alerting signals, symptoms, evidence of occurrence:
Fever and thrombocytopenia occurred in all three cases, and two of the three cases had reported elevations in aspartate transaminase and alanine transaminase, and one of these two cases also had bilirubin elevation. The third case had graft disfunction reported but did not go into detail on the type of dysfunction. Encephalitis only occurred in the case that was fatal.
Demonstration of imputability or root cause:
Of the three cases reported, all three are probable transmission events based on timing of disease development after transplant and in relation to the living donor developing symptoms. The case described by Mathew, et al. also performed sequencing on the donor and recipient, and found 100% homology at the the envelope encoding region. All recipients had been admitted to the hospital, specifically the ICU, for at least 1 week prior to transplant, making a mosquito bite leading to infection less likely.
Imputability grade:
2 Probable
Groups audience:
Keywords:
References:
Suggest new keywords:
living donor liver transplant
vector borne disease
liver function test
thrombocytopenia
Reference attachment:
Suggest references:
1) Mathew JS, Menon VP, et al. Dengue virus transmission from live donor liver graft. Am J Transplant. IN PRESS. doi: 10.1111/ajt.15302
2) Joob B, Wiwanitkit V. Dengue virus transmission from live donor liver graft: a comment [published online ahead of print 2019]. Am J Transplant. https://doi.org/10.1111/ajt.15302
3) Mathew JS, et al. Dengue virus tranmission from live donor liver graft: Comments and clarifications. Am J Transplant. 2019 Feb 15. doi: 10.1111/ajt.15314. [Epub ahead of print]
4) Gupta RK1, Gupta G1, Chorasiya VK1, Bag P2, Shandil R3, Bhatia V3, Wadhawan M3, Vij V1, Kumar A3. Dengue Virus Transmission from Living Donor to Recipient in Liver Transplantation: A Case Report. J Clin Exp Hepatol. 2016 Mar;6(1):59-61.
5) Saigal S, Choudhary NS, Saraf N, Kataria S, Mohanka R, Soin AS. Transmission of dengue virus from a donor to a recipient after living donor liver transplantation. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2013;19(12):1413-4.
Note:
We should merge records 1802 and 1057 with this record. Whoever reviews this record, please decide which record is the most complete (probably this one, plus the events are more contemporary), finish this review, and ask for these 3 records to be merged. I think that there is an opportunity to provide more comprehensive expert comments with this review and very much appreciate the efforts! (MG)
I have added the pdfs for the articles including in entries 1802 and 1057, and my analysis includes information from those cases. **NOTE FROM RNK 7-April-24: I have uploaded papers from records 1057 and 1802. I have added an additional sentence on considering this infection in the setting of living donors who abruptly become ill after transplant.
Expert comments for publication:
The three cases of Dengue Virus Infection in the setting of living donor liver transplant are probable transmission events. The utility of screening all donors in Dengue endemic regions is not clear. However, in a dengue endemic region, if a living donor becomes abruptly ill with abnormal liver enzymes, it may be worthwhile to evaluate both the donor and recipient for Dengue.
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 arboviruses is identified.