The challenges of infection in transplantation: donor-derived infections

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Abstract
Purpose of review Donor-derived infection is well described in solid organ transplantation. Despite the low incidence of such transmission, the organism burden and morbidity of these infections is amplified in the immunocompromised host. In addition, improvements in microbiologic diagnostic tools have increased the recognition of transmission of infection with allografts that would previously have gone undiagnosed. Recent findings The transmission of potential pathogens with tissue allografts includes common viruses such as cytomegalovirus, Epstein-Barr virus and, before the availability of routine screening, hepatitis B and C infections. Other infections, including bacterial or fungal colonization of donor tissues, or latent tuberculosis or toxoplasmosis have been activated in the transplant recipient. However, recent clusters of cases of rapidly fatal donor-derived viral infections have been identified. These have included infections in multiple recipients of organs from single donors due to rabies, lymphocytic choriomeningitis virus, and West Nile virus. Summary Investigation of donor-derived infections requires suspicion on the part of caregivers, utilization of newer diagnostic tools, and coordination of epidemiologic investigations between medical centers and public health authorities.