Donor‐Derived Infections

Publication Date: April 1, 2019

Recommendations

Risk mitigation

All donors should have medical and social histories obtained to identify individuals at increased risk of transmitting HIV, HBV, and HCV. (Low, Strong)
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NAT should be used to test all donors for HCV and in increased risk donors for HIV and HBV. Interpretation of the residual risk of undiagnosed infection in NAT negative donors needs to be contextualized with when the testing was performed relative to the eclipse period post‐exposure. (Low, Strong)
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In living donors, donor testing should be done as soon as practically possible before donation but no later than 28 days prior to organ recovery. Living donors should also be screened for relevant endemically limited infections based on exposure history of the individual donor. (Low, Strong)
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Donors with documented infections

Donors with documented bacteremia should be used with informed consent and involvement of the local Transplant Infectious Diseases team. The donor should be treated with targeted antimicrobial treatment for at least 24‐48 hours, optimally with some degree of clinical response. The recipient should receive 7‐ to 14‐ day course of antibiotics targeted to the organism isolated from the donor. (Moderate, Strong)
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Bacteremic donors should be assessed for metastatic infections, including embolic infection of the graft or endocarditis. Such metastatic infections may make the risk of infection transmission higher and would warrant longer durations of therapy in recipients. (Low, Strong)
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Donors with multi‐drug‐resistant bacterial infections require careful discussion with the Transplant Infectious Diseases team prior to accepting the organs. Risk‐benefit assessment is needed to drive decisions to accept the organ but a clear plan for peritransplant antibiotics should be outlined prior to use of the organs. (Low, Strong)
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Donors with documented bacterial meningitis or N. fowlerii infection can be used with appropriate treatment of the recipient for the infection. (Moderate, Strong)
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Donors with encephalitis of unknown etiology should generally be avoided. (Low, Strong)
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Evaluation of recipients with suspected donor‐derived infections

Any recipient with early post‐transplant infection, atypical clinical course, or early post‐transplant encephalitis should have donorderived disease transmission in the differential diagnosis. (Low, Strong)
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When donor‐derived disease transmission is considered, the recognizing teams should report the concern immediately, but no later than 24 hours after initial consideration, to the relevant OPO and national transplant authority (UNOS for the United States). (Low, Strong)
Sites should not wait to prove donor transmission.
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Recipients of organs from increased risk donors should be screened by HIV, HBV, and HCV NAT at approximately 1 month post‐transplant. Additional screening for HBV, including HBsAg, should be performed approximately 1 year post‐transplant. (Moderate, Strong)
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Recommendation Grading

Disclaimer

Overview

Title

Donor‐Derived Infections

Authoring Organization

Publication Month/Year

April 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation will review the current state of the art of donor‐derived infections. Specifically, the guideline will summarize standardized definitions and approaches to defining imputability, updated data on the epidemiology of donor‐derived infections, and approaches to risk mitigation against transmission of infections.

Target Patient Population

Solid organ transplant donors and recipients

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D019072 - Antibiotic Prophylaxis, D014180 - Transplantation, D019737 - Transplants, D016377 - Organ Transplantation, D060053 - Transplant Donor Site, D046148 - Donor Selection

Keywords

infection prevention, human immunodeficiency virus (HIV), solid organ transplant, infections, donor

Source Citation

Wolfe, CR, Ison, MG; On behalf of the AST Infectious Diseases Community of Practice. Donor‐derived infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13547.