Record number:
579
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
This report describes the first confirmed case of HIV transmission through organ transplantation from a living donor reported since 1989 and the first such transmission documented in the United States since laboratory screening for HIV infection became available in 1985 ( MMWR 2011).
Time to detection:
8 months
Alerting signals, symptoms, evidence of occurrence:
Living donor: the donor reported unprotected sex with one male partner during the 1 year before the transplant; anti-HIV negative 79 days before donation, but anti-HIV positive 1 year post-donation. In lookback, DNA sequences for three HIV genes were amplified from donor leukocytes collected 11 days pretransplant. Recipient: One year after transplant, the recipient was hospitalized with refractory oral and esophageal candidiasis; screening for HIV infection by EIA was positive, and HIV infection was confirmed with a positive Western blot.
Demonstration of imputability or root cause:
The gp41, polymerase, and p17 sequences from the donor and recipient were nearly identical, with greater than 98% identity and tight phylogenetic clustering, suggesting that the two viruses are highly related. The time sequence in which HIV was isolated from frozen specimens, tight phylogenetic clustering of HIV sequences from the donor and recipient, and lack of other HIV exposure risk in the recipient confirmed that HIV was transmitted by transplantation of a kidney from a living donor who was infected after screening negative for HIV infection during his initial evaluation.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest references:
Morbidity and Mortality Weekly Report 2011
Expert comments for publication:
All prospective living organ donors should have their initial serologic tests for HIV supplemented with repeat testing with a combination of an HIV serologic test and a nucleic acid test as close to the time of organ donation as possible, but no longer than 7 days before organ donation (in the case described in this report, the time between initial donor evaluation and transplant surgery was 10 weeks). Clinicians should advise living donors of their obligation to avoid behaviors that would put them at risk for acquiring HIV before organ donation.