Transplanted infections: donor-to-host transmission with the allograft

Article Abstract:

There is some concern regarding the transplantation of organs that are unknowingly infected with disease. Donor tissues and blood are routinely tested for hepatitis, syphilis and systemic infections. Since the human immunodeficiency virus (HIV) is easily transmitted through infected blood, there is some question regarding the transmission of this disease to potential organ recipients. The risk of transmitting diseases to organ recipients from infected donors was studied in all cases reported in the medical literature through January 1988. Recipients can acquire infection from outside sources, from reactivation of latent infections and from organs contaminated during organ processing. Since true donor-to-recipient transmission is difficult to ascertain, only patients with a high degree of certainty were studied. The HIV, cytomegalovirus, herpes simplex virus, Epstein-Barr virus, rabies virus, the virus that causes Jakob-Creutzfeldt disease and hepatitis B virus were found to be transmitted through infected donor organs. Bacterial infections were more likely to be transmitted when infected organs become contaminated during the processing and harvesting of donor organs. The transmission of fungi and yeast was less common. Although true donor-to-recipient infections rarely occur, infections among organ recipients are more likely to be the result of organ contamination during handling. The transmission of infection to organ recipients can be reduced by careful donor screening (laboratory and clinical assessments) and employing measures to reduce contamination of organs during processing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, Organs (Anatomy), Donation of organs, tissues, etc., Tissue donation

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Sequential measurement of beta-2-microglobulin levels, p24 antigen levels, and antibody titers following transplantation of a human immunodeficiency virus-infected kidney allograft

Article Abstract:

An 38-year-old woman who received a kidney by transplantation developed symptoms of AIDS. It was later realized that the kidney was donated from an individual who was infected with the human immunodeficiency virus (HIV) but had no symptoms of disease. Blood samples from the recipient showed that she was not infected with HIV before transplantation. Antibodies to the viral molecule p24 were detected 10 days after the transplant, while antibodies to the viral molecule p41 were detected 49 days after the transplant. Levels of the viral protein p24 were elevated 21 days after the transplant. The levels of beta-2-microglobulin were elevated 14 days after transplantation. Beta-2-microglobulin is a normal host protein that is small in size and detectable in patients with kidney dysfunction because it is not filtered properly. Elevated levels are also found in certain viral diseases, including HIV infection and in other disease states, such as cancer and autoimmune diseases. However, the transplanted kidneys seemed to be functioning normally at the time of the detection of beta-2-microglobulin and remained so until the patient died of AIDS. Therefore, it is believed that the presence of beta-2-microglobulin indicated infection with HIV. This is the first time that the presence of antibodies against viral antigens, the presence of viral molecules and the presence of beta-2-microglobulin were sequentially detected when the exact time of infection was known. Because beta-2-microglobulin is detected early in infection it may be used as a marker for HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, HIV infection, HIV infections, AIDS (Disease), Beta globulins

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HIV-1 and HTLV-I infection in renal transplant recipients

Article Abstract:

The prevalence of infections with retroviruses in kidney transplant recipients was examined. Blood samples from 224 patients undergoing kidney transplantation between 1979 and 1985 were tested for the presence of human immunodeficiency virus (HIV) and human T-cell leukemia virus type I (HTLV-I). Four patients were infected with HIV-1 and two with HTLV-I. All four patients with HIV infection had no evidence of the infection before transplantation, but briefly developed HIV-1 antigenemia, the presence of portions of HIV in the blood that may cause an immune or natural defense reaction. One HIV-1-infected patient with retroviral infection died two years after transplantation, from Kaposi's sarcoma, cancerous growths on the skin and other body sites. Another HIV-1-infected patient remains alive with no symptoms after four years, whereas two other HIV-1-infected patients rejected their transplanted kidneys and are without symptoms, but require hemodialysis to filter their blood. Of the two patients with HTLV-I infection, the retrovirus was detected in one patient before transplantation and in the other patient after receiving the transplant. Both HTLV-I-infected patients are without symptoms three years after kidney transplantation. Intravenous drug use was not a risk factor in these patients, and retroviral infection probably did not result from blood transfusions during transplantation. However, transmission of retroviruses through contaminated donor kidneys should be considered as a cause of retroviral infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

HIV (Viruses), HIV, Kidneys, Kidney transplantation, HTLV-I infections

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