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DONOR-DERIVED INFECTIONS

  • Potential of transmission of diseases from donor to recipient via the transplanted organs

  • Can be encountered with ALL donors

    • However, certain activities and practices increase this potential risk

  • Three main infections considered:

    • Human immunodeficiency virus (HIV)

    • Hepatitis B virus (HBV)

    • Hepatitis C virus (HCV)

RATIONALE1

  • Does NOT address organ quality or expected organ survival

  • Intended to provide clinicians and patients with an estimate of risk of undetected infections based on the known exposures of the donor

  • The donor risk has to be counterbalanced with the recipient risk of:

    • Death from other causes:

      • 0.4% risk of acquiring HIV/HCV from a donor with predisposing activities compared to 0.9% risk of dying from a traffic accident

      • >50% 5-year dialysis mortality

    • Not performing the transplant and waiting for another organ:

      • 5-year survival benefit associated with performing the transplant rather than waiting for another organ has been reported to vary from −6% to +67%2

    • Acquiring HCV/HBV/HIV while on dialysis:

      • 0.34% yearly risk of HCV infection

        • The one-time risk of acquiring HCV from an intravenous drug use (IVDU) donor (which in turn is associated with the greatest risk) is similar to the yearly risk of acquiring HCV while on dialysis

  • Currently available therapies:

    • HIV: can be treated

    • HBV: can be treated

    • HCV: can be cured

TESTING

  • Serological/antibody testing:

    • Longer window (time from infection to detectable antibodies)

  • Nucleic acid testing (NAT)

    • Very short window

    • Estimated 10-fold reduction in window with respect to antibody testing

WINDOW1

  • Risk of infection is reduced if the inciting activity:

    • Occurred more than 3 weeks prior to NAT testing

    • Involved incarceration/sexual practices rather than IVDU

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PATHOGEN

WINDOW (NAT TESTING)

HCV

3–5 days

HIV

5–6 days

HBV

20–22 days

RISK OF INFECTION IN WINDOW1

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EXPOSURE

RELATIVE RISK OF INFECTION IN WINDOW PERIOD BY TESTING METHOD

HCV

HIV

NAT

ANTIBODY – ELISA

NAT

ANTIBODY – ELISA

IV DRUGS

0.32%

3%

<0.1%

0.12%

SEXUAL

0.12%

1.2%

<0.1%

<0.1%

BLOOD PRODUCT

<0.1%

<0.1%

<0.1%

<0.1%

REPORTED INFECTIONS3

  • Reported transmissions to the United States Organ Procurement and Transplantation Network Disease Transmission Advisory Committee for the period 2008–2018:

    • HIV: 1 case

    • HCV: 23 cases

    • HBV: 14 cases

CURRENT CRITERIA FOR KIDNEY TRANSPLANTATION3-5

  • 2020 Risk Assessment of Living and Deceased Donors recommended guidelines by the U.S. Public Health Service:

    • Risk criteria (during the 30 days before organ procurement):

      • Sex (i.e., any method of sexual contact, including vaginal, anal, and oral) with a person known or suspected to have HIV, HBV, or HCV infection

      • Man who has had sex with another man

      • Sex in exchange for ...

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