TY - JOUR
T1 - Cryptococcus transmission through solid organ transplantation in the United States
T2 - A report from the Ad Hoc Disease Transmission Advisory Committee
AU - Penumarthi, Lasya R.
AU - La Hoz, Ricardo M.
AU - Wolfe, Cameron R.
AU - Jackson, Brendan R.
AU - Mehta, Aneesh K.
AU - Malinis, Maricar
AU - Danziger-Isakov, Lara
AU - Strasfeld, Lynne
AU - Florescu, Diana F.
AU - Vece, Gabriel
AU - Basavaraju, Sridhar V.
AU - Michaels, Marian G.
N1 - Funding Information:
The authors acknowledge the contributions of the OPTN Ad Hoc Disease Transmission Advisory Committee members who participated in case adjudication and supporting staff including Susan Tlusty, Emily Ward, Cassandra Meekins, and Sandy Bartal. The authors thank CDC Mycotic Disease Branch staff for work in investigating these cases.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/5
Y1 - 2021/5
N2 - Cryptococcus species can cause serious life-threatening infection in solid organ transplant recipients by reactivation of prior infection, posttransplant de novo infection, or donor transmission from the transplanted organ. Although previously reported in the literature, the extent of donor-derived cryptococcosis in the United States has not been documented. We analyzed potential donor-derived Cryptococcus transmission events reported to the Organ Procurement and Transplantation Network (OPTN) for investigation by the Ad Hoc Disease Transmission Advisory Committee (DTAC). All reports between 2009 and 2019 in which transmission to recipients was designated proven or probable, or determined to be averted due to implementation of prophylaxis (intervention without disease transmission—“IWDT”) were included. During 2009–2019, 58 reports of potential donor-derived cryptococcosis were submitted to DTAC. Among these reports, 12 donors were determined to have resulted in proven or probable transmission to 23/34 (67.6%) recipients. Most of these donors (10/12 [83%]) exhibited central nervous system-related symptoms prior to death and 5/23 (22%) infected recipients died. For 11 different donors, prophylaxis, most often with fluconazole, was administered to 23/35 (65.7%) recipients. Clinicians should maintain awareness of donor-derived cryptococcosis and consider prompt prophylaxis or treatment followed by reporting to OPTN for further investigation.
AB - Cryptococcus species can cause serious life-threatening infection in solid organ transplant recipients by reactivation of prior infection, posttransplant de novo infection, or donor transmission from the transplanted organ. Although previously reported in the literature, the extent of donor-derived cryptococcosis in the United States has not been documented. We analyzed potential donor-derived Cryptococcus transmission events reported to the Organ Procurement and Transplantation Network (OPTN) for investigation by the Ad Hoc Disease Transmission Advisory Committee (DTAC). All reports between 2009 and 2019 in which transmission to recipients was designated proven or probable, or determined to be averted due to implementation of prophylaxis (intervention without disease transmission—“IWDT”) were included. During 2009–2019, 58 reports of potential donor-derived cryptococcosis were submitted to DTAC. Among these reports, 12 donors were determined to have resulted in proven or probable transmission to 23/34 (67.6%) recipients. Most of these donors (10/12 [83%]) exhibited central nervous system-related symptoms prior to death and 5/23 (22%) infected recipients died. For 11 different donors, prophylaxis, most often with fluconazole, was administered to 23/35 (65.7%) recipients. Clinicians should maintain awareness of donor-derived cryptococcosis and consider prompt prophylaxis or treatment followed by reporting to OPTN for further investigation.
KW - antibiotic prophylaxis
KW - antibiotic: antifungal
KW - clinical research / practice
KW - donors and donation: donor-derived infections
KW - infection and infectious agents - fungal
KW - infectious disease
KW - organ procurement and allocation
KW - organ transplantation in general
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U2 - 10.1111/ajt.16433
DO - 10.1111/ajt.16433
M3 - Article
C2 - 33290629
AN - SCOPUS:85100305546
SN - 1600-6135
VL - 21
SP - 1911
EP - 1923
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -