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.

Transmission of human immunodeficiency virus (HIV) by transplantation: clinical aspects and time course analysis of viral antigenemia and antibody production.

The human immunodeficiency virus (HIV) was transmitted to a patient who received a cadaveric renal transplant from a donor who had received massive blood component replacement. A negative HIV antibody test was obtained on serum drawn immediately after transfusion. After transplantation, pretransfusion sera and sera obtained several hours after transfusion tested positive for HIV antibody, suggesting that transfusions had transiently diluted the patient's serum and resulted in a false-negative HIV antibody test. Immediately after transplantation, the recipient showed a transient increase in HIV antigen levels followed by a more sustained increase representing de-novo antigen synthesis. Antibodies to HIV were detected 51 days after transplant. The recipient has shown no signs or symptoms of HIV infection after 1 year. In potential cadaveric organ donors, HIV antibody testing should be performed on pretransfusion sera or on sera obtained several hours after massive transfusion of blood products.

Nosocomial transmission of a strain of Staphylococcus aureus causing toxic shock syndrome.

A strain of Staphylococcus aureus producing toxic shock syndrome toxin-1 was repeatedly isolated from the nares of a neurosurgeon. This strain was identical to strains cultured from two of his patients who developed toxic shock syndrome after laminectomy. The relatedness of the isolates was shown by Southern blot hybridization analyses using chromosomal transposons as probes. This approach should be considered, in addition to standard bacteriologic techniques, as an effective method to analyze the relatedness of nosocomial isolates.

An outbreak of Nocardia asteroides infection in a renal transplant unit.

An outbreak of Nocardia asteroides infection occurred in the nephro-urological intensive care unit, St. Peter's Group of Hospitals, London in 1979. In is suggested that the outbreak has been due to patient-to-patient transmission. Five months before the outbreak. N. asteroides was first isolated from nephrostomy urine from an asymptomatic patient who had undergone several urological operations. Subsequently six of the seven patients admitted for renal transplant over a three month period developed proven infections. The first transplant patient had an abdominal abscess and the other five had only pulmonary disease with obvious radiological lesions. Bacteriological diagnosis was made in three patients by examination of sputum and in the other three from bronchoscopic specimen, pleural fluid and pus from an abscess respectively. Five of the six renal transplant patients were treated with amoxycillin and erythromycin. Clinical and radiological improvement was observed and no patient died as a result of the infection. In the intensive care unit air and dust samplings were positive for N. Asteroides. The unit was closed and fumigated with formaldehyde and when the air sampling continued to be negative the unit was then re-opened.

Epidemiologic Surveillance for Staphylococcus epidermidis infections related to cardiopulmonary bypass.

Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.