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Transplant Safety: Recognizing Donor-Derived InfectionsExternalExternal

Estimates of Infection

Transplant transmitted infections are very rare. They are suspected in about 1% of transplants and confirmed in far fewer (Kaul, et al).

Pertinent Published Reports of CDC Investigated Infectious Diseases Transmitted through Transplantation – United States (2000 – 2021)
Virus Transmissions
  • CDC Expert Commentary

    Susan N. Hocevar, MD, is a medical epidemiologist in the Surveillance Branch in the Division of Healthcare Quality Promotion (DHQP), National Center for Emerging and Zoonotic Infections Diseases (NCEZID), Centers for Disease Control and Prevention (CDC).

    Transplant Safety: Recognizing Donor-Derived Infections Microsporidiosis is an emerging transplant-associated infection, and CDC depends on astute clinicians to recognize the signs of this and other donor-derived diseases. February 2014

    Rebecca J. Free, Pallavi Annambhotla, Ricardo M. La Hoz, Lara Danziger-Isakov, Jefferson M. Jones, Lijuan Wang, Senthil Sankthivel, Marilyn E. Levi, Marian G. Michaels, Wendi Kuhnert, David Klassen, Sridhar V. Basavaraju, Ian T. Kracalik, Risk of SARS-CoV-2 transmission through solid organ transplantation and outcomes of COVID-19 among recent transplant recipients, Open Forum Infectious Diseases, 2022;, ofac221, https://doi.org/10.1093/ofid/ofac221

  • Bixler D, Annambhotla P, Montgomery M, et al. Unexpected hepatitis B virus infection after liver transplantation — United States, 2014–2019. American Journal of Transplantation. 09/01 2021;21:3190-3195. doi:10.1111/ajt.16045
  • Soto R, McDonald E, Annambhotla P, et al. West Nile Virus Transmission by Solid Organ Transplantation and Considerations for Organ Donor Screening Practices, United States. Emerging infectious diseases. 11/29 2021;28doi:10.3201/eid2802.211697
  • Sherman A, Lu X, Schneider E, et al. Human Adenovirus 11 in 2 Renal Transplant Recipients: Suspected Donor-Derived Infection. Open Forum Infectious Diseases. 02/25 2021;8doi:10.1093/ofid/ofab092
  • Dollard S, Annambhotla P, Wong P, et al. Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior. American Journal of Transplantation. 07/01 2020;21doi:10.1111/ajt.16181
  • Pouch SM, et al. Transmission of Eastern Equine Encephalitis Virus from an Organ Donor to Three Transplant Recipients. Clinical Infectious Disease. 2018 Oct 29 (epub ahead of print).
  • Dollard SC, et al. Donor-derived Kaposi’s sarcoma in a liver-kidney transplant recipient. Am J Transplant. 2018 Feb;18(2):510-513.
  • White, S. L., Rawlinson, W., Boan, P., Sheppeard, V., Wong, G., Waller, K., Opdam, H., Kaldor, J., Fink, M., Verran, D., Webster, A., Wyburn, K., Grayson, L., Glanville, A., Cross, N., Irish, A., Coates, T., Griffin, A., Snell, G., Alexander, S. I., … Ison, M. (2018). Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission. Transplantation direct, 5(1), e416. https://doi.org/10.1097/TXD.0000000000000852
  • Foster MA, et al. Transmission of Hepatitis A Virus through Combined Liver-Small Intestine-Pancreas Transplantation. Emerg Infect Dis. 2017 Apr;23(4):590-596.
  • MA Foster, LM Weil, S Lin, T Johnson, T Hayden, Y Khudyakov, PD Annambhotla, SV Basavaraju, S Kamili, JM Ritter, N Nelson, G Mazariegos, M Green, RW. Himes, DT Kuhar, MJ Kuehnert, JA Miller, R Wiseman, AC Moorman. Transmission of Hepatitis A virus through combined liver-small intestine-pancreas transplantation. Emerg Infect Dis. 2017 Apr;23(4):590-596. doi: 10.3201/eid2304.161532.
  • Mathur, K. Yadav, B. Ford, I.J. Schafer, SV Basavaraju, B Knust, W. Shieh, S. Hill, GD Locke, P. Quinlisk, S. Brown, A. Gibbons, D. Cannon, M. Kuehnert, ST Nichol, PE Rollin, U Ströher, R.Miller. High clinical suspicion of donor-derived disease leads to timely recognition and early intervention to treat solid organ transplant-transmitted Lymphocytic Choriomeningitis Virus. Transpl Infect Dis. 2017 Apr 19. doi: 10.1111/tid.12707. [Epub ahead of print].
  • Suryaprasad A, et al. Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening. Am J Transplant. 2015 Jul;15(7):1827-35.
  • Vora NM, et al. Raccoon rabies virus variant transmission through solid organ transplantation. 2013 Jul 24; 310(4):398-407.
  • Blau DM, et al. West Nile virus RNA in tissues from donor associated with transmission to organ transplant recipients. Emerg Infect Dis. 2013;19(9):1518-20.
  • Macneil A, et al. Solid organ transplant-associated lymphocytic choriomeningitis, United States, 2011. Emerg Infect Dis. 2012 Aug;18(8):1256-62.
  • MacNeil, A., et al. Solid organ transplant-associated lymphocytic choriomeningitis, United States, 2011, Emerging Infectious Diseases, 2012. 18(8):1256-1262Fischer SA, et al. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006;354:2235–49.
  • Ison MG, et al. Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients. Am J Transplant. 2011 Jun;11(6):1218-25.
  • Transmission of hepatitis C virus through transplanted organs and tissue—Kentucky and Massachusetts, 2011 [published erratum appears in MMWR Morb Mortal Wkly Rep 2012;61(4):80]. MMWR Morb Mortal Wkly Rep 2011;60(50):1697-700.
  • Ison, M.G., Llata, E, Conover, C S, et al., Transmission of human immunodeficiency virus and hepatitis C from an organ donor to four transplant recipients. Am J Transplant, 2011. 11(6):1218-1225.
  • HIV Transmitted from a Living Organ Donor — New York City, 2009. MMWR Morb Mortal Wkly Rep. 2011. 60(10):297-301.
  • Notes from the Field: Transplant-Transmitted Hepatitis B Virus – United States, 2010. MMWR Morb Mortal Wkly Rep. 2011. 60(32):1087.
  • Potential Transmission of Viral Hepatitis through Use of Stored Vessels as Conduits in Organ Transplantation – Pennsylvania, 2009. MMWR Morb Mortal Wkly Rep. 2011:60(6):172-174.
  • West Nile Virus Transmission via Organ Transplantation and Blood Transfusion — Louisiana, 2008. MMWR Morb Mortal Wkly Rep. 2009. 58(45):1263-1267.
  • Potential Transmission of Viral Hepatitis through Use of Stored Vessels as Conduits in Organ Transplantation – Pennsylvania, 2009. MMWR Morb Mortal Wkly Rep. 2011:60(6):172-174.
  • West Nile virus transmission via organ transplantation and blood transfusion—Louisiana, 2008. MMWR Morb Mortal Wkly Rep. 2009;58:1263–7.
  • Brief report: lymphocytic choriomeningitis virus transmitted through solid organ transplantation- Massachusetts, 2008. MMWR Morb Mortal Wkly Rep. 2008;57:799–801.
  • Brief Report: Lymphocytic Choriomeningitis Virus Transmitted Through Solid Organ Transplantation — Massachusetts, 2008. MMWR Morb Mortal Wkly Rep. 2008. 57(29):799-801.
  • Fischer, S.A., et al., Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med, 2006. 354(21):2235-49.CDC.
  • West Nile Virus Infections in Organ Transplant Recipients — New York and Pennsylvania, August–September, 2005. MMWR Morb Mortal Wkly Rep. 2005. 54(40):1021-1023.
  • Srinivasan, A., et al., Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med, 2005. 352(11):1103-11.Srinivasan A, et al. Transmission of rabies virus from an organ donor to four transplant recipients. NEJM. 2005;352:1103–11.
  • Lymphocytic choriomeningitis virus infection in organ transplant recipients—Massachusetts, Rhode Island, 2005. MMWR Morb Mortal Wkly Rep. 2005;54:537–9.
  • West Nile virus infections in organ transplant recipients—New York and Pennsylvania, August–September, 2005. MMWR Morb Mortal Wkly Rep.2005;54:1021–3.
  • Public Health Dispatch: West Nile Virus Infection in Organ Donor and Transplant Recipients — Georgia and Florida, 2002. MMWR Morb Mortal Wkly Rep. 2002. 51(35):790.
  • Update: Investigation of West Nile Virus infections in recipients of organ transplantation and blood transfusion – Michigan, 2002. MMWR Morb Mortal Wkly Rep. 2002. 51(39):879.
  • Hepatitis C Virus Transmission from an Antibody-Negative Organ and Tissue Donor — United States, 2000–2002. MMWR Morb Mortal Wkly Rep. 2003. 52(13):273-276.
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Bacteria Transmissions
  • Malinis M, La Hoz RM, Vece G, Annambhotla P, Aslam S, Basavaraju SV, Bucio J, Danziger-Isakov L, Florescu DF, Jones JM, Rana M, Wolfe CR, Michaels MG. Donor-derived tuberculosis among solid organ transplant recipients in the United States-2008 to 2018. Transpl Infect Dis. 2022 Apr;24(2):e13800. doi: 10.1111/tid.13800. Epub 2022 Feb 4. PMID: 35064737.
  • Li R, Wilson W, Schwartz N, et al. Notes from the Field: Tuberculosis Outbreak Linked to a Contaminated Bone Graft Product Used in Spinal Surgery – Delaware, March-June 2021. MMWR Morbidity and mortality weekly report. 09/10 2021;70:1261-1263. doi:10.15585/mmwr.mm7036a4
  • Saha A, Browning C, Dandamudi R, et al. Donor-derived Ehrlichiosis: 2 Clusters Following Solid Organ Transplantation. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 07/30 2021;doi:10.1093/cid/ciab667
  • Mowla S, Drexler N, Cherry C, Annambholta P, Kracalik I, Basavaraju S. Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerging Infectious Diseases. 11/01 2021;27doi:10.3201/eid2711.211127
  • Bardossy A, Snavely E, Nazarian E, et al. Donor‐derived transmission through lung transplantation of carbapenem‐resistant Acinetobacter baumannii producing the OXA‐23 carbapenemase during an ongoing healthcare facility outbreak. Transplant Infectious Disease. 02/01 2020;22doi:10.1111/tid.13256
  • Jones JM, Vikram HR, Lauzardo M, Hill A, Jones J, Haley C, Seaworth B, Oldham S, Brown M, Gutierrez F, Basavaraju SV. Tuberculosis transmission across three states: The story of a solid organ donor born in an endemic country, 2018. Transpl Infect Dis. 2020 Dec;22(6):e13357. doi: 10.1111/tid.13357. Epub 2020 Jul 8. PMID: 32510808; PMCID: PMC7879577.
  • Nelson C, Murua C, Jones J, et al. Francisella tularensis Transmission by Solid Organ Transplantation, 20171. Emerging Infectious Diseases. 04/01 2019;25doi:10.3201/eid2504.181807
  • Jones S, Jones J, Leung V, et al. Sepsis Attributed to Bacterial Contamination of Platelets Associated with a Potential Common Source — Multiple States, 2018. MMWR Morbidity and Mortality Weekly Report. 06/14 2019;68:519-523. doi:10.15585/mmwr.mm6823a2Novosad SAet al. Mycoplasma hominis Infections Transmitted Through Amniotic Tissue Product. Clin Infect Dis. 2017 Oct 1;65(7):1152-1158.
  • SA Novosad, SV Basavaraju, M. Mohr, P Annambhotla, A. Halpin, L. Foy, R Chmielewski, JM Winchell, AJ Benitez, SS Morrison, T Johnson, DM Crabb, AE Ratliff, K. Waites, MJ Kuehnert. Mycoplasma hominis Infections Transmitted through Amniotic Tissue Product. Clin Infect Dis. 2017 Oct 1;65(7):1152-1158.
  • Kay A, et al. Solid Organ Transplant-Transmitted Tuberculosis Linked to a Community Outbreak – California, 2015..Am J Transplant. 2017 Oct;17(10):2733-2736.
  • Wendt JM, et al. Transmission of methicillin-resistant Staphylococcus aureus infection through solid organ transplantation: confirmation via whole genome sequencing. Am J Transplant. 2014 Nov; 14(11):2633-9.
  • Transmission of Multidrug-Resistant Escherichia coli through Kidney Transplantation – California and Texas, 2009. MMWR Morb Mortal Wkly Rep. 2010. 59(50): p. 1642-1646.
  • Cartwright, E.J., et al., Transmission of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) to tissue-allograft recipients: a report of two cases. J Bone Joint Surg Am, 2010. 92(6): p. 1501-6.
  • Transplantation-Transmitted Tuberculosis — Oklahoma and Texas, 2007. MMWR, 2007. 57(13): p. 333-336.
  • Winthrop, K.L., et al., Transmission of mycobacterium tuberculosis via lung transplantation. Am J Transplant, 2004. 4(9): p. 1529-33.
  • Kainer, M.A., et al.. Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med, 2004. 350(25): p. 2564-71.
  • Clostridial Endophthalmitis after Cornea Transplantation — Florida, 2003. MMWR Morb Mortal Wkly Rep. 2003. 52(48): p. 1176-1179.
  • Invasive Streptococcus pyogenes After Allograft Implantation — Colorado, 2003. MMWR Morb Mortal Wkly Rep. 2003. 52(48): p. 1173-1176.
  • Septic Arthritis Following Anterior Cruciate Ligament Reconstruction Using Tendon Allografts — Florida and Louisiana, 2000. MMWR Morb Mortal Wkly Rep. 2001. 50(48): p. 1081-1083.
  • Update: Allograft-Associated Bacterial Infections — United States, 2002. MMWR, 2002. 51(10): p. 207-210.
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Fungus Transmissions
  • Natarajan P, Lockhart S, Basavaraju S, et al. Donor‐derived Cryptococcus gattii sensu stricto infection in two kidney transplant recipients, southeastern United States. American Journal of Transplantation. 06/01 2021;21doi:10.1111/ajt.16729
  • Penumarthi L, Hoz R, Wolfe C, et al. Cryptococcus transmission through solid organ transplantation in the United States: A Report from the Ad Hoc Disease Transmission Advisory Committee. American Journal of Transplantation. 12/08 2020;21doi:10.1111/ajt.16433
  • Dellière S, Gits-Muselli M, Bretagne S, Alanio A. Outbreak-Causing Fungi: Pneumocystis jirovecii. Mycopathologia. 2020 Oct;185(5):783-800. doi: 10.1007/s11046-019-00408-w. Epub 2019 Nov 28. PMID: 31782069.
  • Smith RM, et al. Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis. Emerg Infect Dis. 2017 Mar;23(3):387-395.
  • Hocevar SN, et al. Microsporidiosis acquired through solid organ transplantation: a public health investigation. Ann Intern Med. 2014
  • Engelthaler, D.M., et al. Next-generation sequencing of Coccidioides immitis isolated during cluster investigation. Emerg Infect Dis, 2011. 17(2): p. 227-32.
  • Baddley, J.W., et al. Transmission of Cryptococcus neoformans by Organ Transplantation. Clin Infect Dis, 2011. 52(4): p. e94-8.
  • Alexander, B.D., et al., Fatal Apophysomyces elegans infection transmitted by deceased donor renal allografts. Am J Transplant, 2010. 10(9): p. 2161-7.
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Parasite Transmissions
  • Abanyie FA, et al. Organ Donor Screening Practices for Strongyloides stercoralis Infection among US Organ Procurement Organizations. Transplant Infectious Disease. 2018: 20(3): e12865.
  • Gray EB, et al. Reactivation of Chagas disease among heart transplant recipients in the United States, 2012‐ Transpl Infect Dis. 2018;e12996. https://doi.org/10.1111/tid.12996
  • Farnon EC, et al. Transmission of Balamuthia mandrillaris by Organ Transplantation. Clin Infect Dis. 2016 Oct 1;63(7):878-888.
  • Abanyie FA, et al., Donor-Derived Strongyloides stercoralis Infection in Solid Organ Transplant Recipients in the United States, 2009-2013 Am J Transplant. 2015: 15(5):1369–75.
  • Transmission of Strongyloides stercoralis through transplantation of solid organs – Pennsylvania, 2012.  MMWR, 2013. 62(14);264-266.
  • Balamuthia mandrillaris Transmitted through Organ Transplantation – Mississippi, 2009. MMWR, 2010. 59(36):1165-1170.
  • Notes from the Field: Transplant-Transmitted Balamuthia mandrillaris — Arizona, 2010. MMWR, 2010. 59(36):1182.
  • Kun, H, et al. Transmission of Trypanosoma cruzi by heart transplantation, Clin Infect Dis, 2009. 48:1534-40.
  • Chagas Disease after Organ Transplantation – Los Angeles, California, 2006. MMWR, 2006. 55(29): p. 798-800.
  • Chagas Disease after Organ Transplantation – United States, 2001. MMWR, 2002. 51(10): p. 210-212.
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Other Publications
Reference:

Kaul DR, Vece G, Blumberg E, La Hoz RM, Ison MG, Green M, Pruett T, Nalesnik MA, Tlusty SM, Wilk AR, Wolfe CR, Michaels MG. Ten years of donor-derived disease: A report of the disease transmission advisory committee. Am J Transplant. 2021 Feb;21(2):689-702. doi: 10.1111/ajt.16178. Epub 2020 Jul 25. PMID: 32627325.

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