Transplanted infections: donor-to-host transmission with the allograft

PURPOSE: To evaluate the transmission of infectious agents from organ donors to transplant recipients, and to assess risk factors for transmission, primarily in recipients of kidney, cornea, and heart allografts. DATA IDENTIFICATION: Computerized literature searches of MEDLINE and PAPERCHASE through January 1988, extensive review of references from identified articles, and review of major clinical and transplantation journals through June 1988. STUDY SELECTION: All case reports and studies that reported a possible donor-to-recipient transmission of infection were selected and reviewed. DATA EXTRACTION: Each case report or patient series of donor-to-recipient transmission was judged as possible, probable, or proven depending on the completeness of donor and recipient information available and the likelihood of alternate causes of infection. RESULTS OF DATA SYNTHESIS: True donor-transmitted infection can occur with viruses including human immunodeficiency virus, cytomegalovirus, herpes simplex, Epstein-Barr, rabies, the virus causing Creutzfeldt-Jakob disease, and with hepatitis B virus. It can also occur with many common aerobic bacteria, although allograft-transmitted bacterial infection is more often caused by contamination during harvesting and processing. Fungi and yeast, as well as toxoplasmosis, have been transmitted less frequently, and there have been rare instances when mycobacterial infection, malaria, trypanosomiasis, and strongyloidiasis have been transplanted with the donor organ. CONCLUSIONS: Infection can be transmitted with a donor organ to the recipient, but contamination of the organ during processing and harvesting is commoner and may lead to severe infection in the recipient, especially if contamination is by one of a subset of more virulent organisms. True donor-transmitted infection, although rare, can be reduced by careful donor screening, which should include clinical and epidemiologic assessment for evidence of infection, as well as judicious laboratory testing.