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CDC confirmed HIV transmission via kidney transplant

Bernard MA. MMWR. 2011;60:297-301.

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The CDC has confirmed a case of HIV transmission via kidney transplant from a living donor in New York City during 2010, according to a recent Morbidity and Mortality Weekly Report.

“To reduce the risk for transmission of HIV through living-donor organ transplantation, transplant centers should screen living donors for HIV as close to the time of organ recovery and transplantation as possible, using sensitive tests for both chronic and acute infections, namely, serology and nucleic acid testing,” CDC researchers wrote. “Furthermore, clinicians should inform transplant candidates of the potential risks for disease transmission and advise donors during evaluation of their obligation to avoid behaviors that would put them at risk for acquiring HIV before organ donation.”

The New York City Department of Health and Mental Hygiene were notified of a potential transplant-related HIV infection in NYC during 2010. After HIV was confirmed in both the adult donor and recipient, concerns were raised about the possibility of HIV transmission via organ transplant.

Twelve days prior to the kidney transplant, the recipient tested negative for HIV, with an initial CD4 cell count less than 100 cells/mcL. The recipient did not have any history of sexually transmitted infections, injection drug use, sex with injection drug users, or other high-risk sexual activity. After the transplant, the patient had multiple hospitalizations for febrile illness, renal insufficiency and evaluation for possible rejection of the transplanted kidney.

A public health investigation commenced and both the donor and recipient were interviewed in person. The donor reported unprotected sex with one male partner within 1 year before the transplant and did not know the male partner’s HIV status.

Whole blood samples were pooled from both the donor and recipient for analysis at the CDC 404 days after the transplant. Results indicated a greater than 98% identity and tight phylogenetic clustering of the gp41, polymerase, and p17 sequences from the donor and recipient, according to the researchers.

“To reduce the risk for transplant-transmitted HIV infection, living donors should be rescreened with both HIV serologic tests and nucleic acid testing as close to the time of organ recovery as logistically feasible, but no longer than 7 days before organ donation,” CDC researchers wrote in an accompanying editorial. “In addition, clinicians should advise living donors of their obligation to avoid behaviors that would put them at risk for acquiring HIV before organ donation. Because nucleic acid testing cannot detect HIV infections during the eclipse period, all transplant candidates should be informed during the evaluation process that despite donor screening, a very small risk remains that they could acquire HIV or other infections as a result of transplantation. All suspected cases of transplant-associated HIV transmission should be reported to appropriate public health authorities and to Organ Procurement and Transplant Network.”

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