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AJT article reports on 10 years of potential donor-derived transmission events

AJT article reports on 10 years of potential donor-derived transmission events

It is very rare for patients receiving transplants to have a donor-derived disease transmission, according to a July study published online in the American Journal of Transplantation. The study, which analyzed a decade of incidents hospitals reported to the Organ Procurement and Transplantation Network, found that such diseases occur in about 18 of every 10,000 patients.

“Although donor-derived transmission is rare, significant graft and patient mortality is associated with it,” said Daniel R. Kaul, M.D., professor of infectious diseases at the University of Michigan Medical School. Kaul authored the article along with members of the OPTN Ad Hoc Disease Transmission Advisory Committee and United Network for Organ Sharing researchers.

DTAC used a classification algorithm to measure the strength of evidence that a potential donor-derived transmission event (PDDTE) was a true instance of donor-derived transmission. Proven and probable cases were considered to be true transmissions for the purposes of the report.

Various committee members participated in conducting a review of PDDTE cases reported to the OPTN during the past 10 years—the first aggregate review in that large of a time period—to identify patterns in the types of potential cases, the time to disease presentation, and other characteristics of the potential cases. “This work was intended to help the transplant community better evaluate the risk of transmission associated with various donor conditions, and assist in the early identification of donor-derived disease,” Kaul said.

Study findings included:

  • The rate of donor-derived disease transmissions that occurred varied, with transmissions of viral and bacterial pathogens among the most common.
  • Almost one-third of patients with proven or probable donor-derived transmission died or experienced graft loss after receiving a transplant. While less prevalent than infections, malignancies in particular accounted for a disproportionate number of deaths and graft failure, at nearly 38 percent.

“We hope that this research helps patients understand the inherent risks of transplant and, though the risk of disease transmission is low, we hope it encourages patients to have informed discussions with their doctors about the organs that are right for them,” Kaul said.

UNOS assistant director of research Amber Wilk, Ph.D., added that she anticipates that the research findings will help health care teams at transplant hospitals. “We hope that hospitals—particularly smaller hospitals that might not have a large team of infectious disease experts to rely on—will use our study findings to help support a high index of suspicion with which to respond to potential transmissions whenever they may occur,” Wilk said, adding that the data indicated that early prophylaxis was often associated with good outcomes. “Remaining vigilant for, and suspicious of, the possibility of transmission—even when it isn’t clear that it has occurred—is important for ensuring the best possible outcomes for patients,” she said.

The researchers added that the report highlights the value of the patient safety reporting mechanisms maintained by the OPTN. “Donor-derived transmissions are often too rare for any one program to accumulate a large history of cases from which to draw insights,” said UNOS research analyst Gabe Vece. “We hope the community finds the findings in aggregate helpful, and continues to report PDDTE, as they have, to make reviews like this one a possibility.”

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