Cryptococcus transmission through solid organ transplantation in the United States: A report from the Ad Hoc Disease Transmission Advisory Committee

• Published in: American journal of transplantation Vol. 21; no. 5; pp. 1911 - 1923
• Main Authors: Penumarthi, Lasya R., La Hoz, Ricardo M., Wolfe, Cameron R., Jackson, Brendan R., Mehta, Aneesh K., Malinis, Maricar, Danziger‐Isakov, Lara, Strasfeld, Lynne, Florescu, Diana F., Vece, Gabriel, Basavaraju, Sridhar V., Michaels, Marian G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.05.2021
• Subjects: Advisory Committees; antibiotic prophylaxis; antibiotic: antifungal; Antibiotics; Antifungal agents; Blood & organ donations; Central nervous system; clinical research / practice; Cryptococcosis; Cryptococcus; Disease prevention; Disease transmission; Donors; donors and donation: donor‐derived infections; Fluconazole; Fungal infections; Humans; infection and infectious agents ‐ fungal; Infections; infectious disease; organ procurement and allocation; Organ Transplantation - adverse effects; organ transplantation in general; Prophylaxis; Tissue Donors; Transplant Recipients; Transplantation; Transplants & implants; United States - epidemiology; United States; United States > US; infectious disease; organ transplantation in general; donors and donation: donor-derived infections; infection and infectious agents - fungal; organ procurement and allocation; antibiotic prophylaxis; antibiotic: antifungal; clinical research / practice
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.16433

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. When accepting organs from donors with neurologic symptoms or immunocompromising conditions, transplant centers should be aware of the risk posed of donor‐derived cryptococcus infection in transplant recipients, which has been rare but can be severe.