CDC Reports Rare Case of HIV Infection from Living Kidney Donor

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The Centers for Disease Control and Prevention (CDC) reports the first documented case of HIV in the U.S. contracted from a living organ donor. The New York kidney transplant patient contracted HIV in 2009 from a living organ donor.

The case, reported in the March 18 issue of Morbidity and Mortality Weekly Report, is the first documented case since a 1989 kidney transplant from a living donor in Italy.

This case represents the first such case known in the U.S. since laboratory screening for the HIV virus became possible in 1985. As this case highlights, the need for repeat HIV screening for all living donors as close to the time of organ donation as logistically feasible is very important.

The time sequence in which HIV was isolated from the donor and recipient, and lack of other HIV exposure risk in the recipient confirmed that HIV was transmitted by transplantation of the kidney from the living donor who was infected after screening negative for HIV infection during his initial evaluation.

The CDC reported, that in this particular case, an hemodialysis-dependent renal failure adult patient received a kidney transplant from a living donor at a New York City hospital.

The kidney transplant recipient tested negative for HIV by enzyme immunoassay 12 days before the transplant. This individual did not have a history of sexually transmitted infections, injection drug use, sex with injection drug users, or other high-risk sexual activity.

The kidney donor had reported a previous diagnosis of syphilis and a history of sex with male partners. Laboratory screening 79 days before the transplant showed no evidence of HIV (by enzyme immunoassay), hepatitis B, or hepatitis C.

During the year following the kidney transplant surgery, the kidney recipient patient was frequently ill with fevers, episodes of renal insufficiency, and fears of organ rejection.

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On day 375 after the transplant, the patient was admitted to the hospital for refractory oral and esophageal candidiasis and tested positive for HIV.

The kidney donor was found to be HIV-positive a year after the transplant, after seeking screening for sexually transmitted infections.

Retrospective analysis of stored blood samples by the CDC, using nucleic acid testing, showed that the donor was HIV-negative 57 days before the transplant, but positive 11 days before.

The recipient, on the other hand, was negative by nucleic acid testing 11 days before the procedure but positive 12 days afterward.

Reports of confirmed, donor-derived HIV transmission are rare but notable and have important implications for public health when they occur despite screening. The annual number of living donors increased from 1,829 to 6,609 during 1988--2009.*

Although the Organ Procurement and Transplantation Network (OPTN) sets national policies for organ allocation, including screening potential donors for HIV and other infections, current OPTN policies do not address screening and counseling for HIV infection in living potential donors.

It is important that repeat HIV screening for all living donors as close to the time of organ donation as logistically feasible be done. Screening should include a combination of HIV serologic and nucleic acid methods to rule out acute or recent HIV infection in living donors before organ donation.

The CDC also suggests clinicians should advise living donors of their obligation to avoid behaviors that would put them at risk for acquiring HIV before organ donation.

Source
Centers for Disease Control and Prevention "HIV transmitted from a living organ donor -- New York City, 2009" MMWR 2011; 60: 297-301.

Kucirka LM, et al "Provider response to a rare but highly publicized transmission of HIV through solid organ transplantation" Arch Surg 2011; 146(1): 41-45.

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