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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation will review the current state of the art of donor-derived infections. Specifically, the guideline will summarize standardized definitions and approaches to defining imputability, updated data on the epidemiology of donor-derived infections, and approaches to risk mitigation against transmission of infections. This update will additionally provide guidance on the use of HIV+...
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Characteristics of transplant candidates can significantly impact risk for infection after transplantation and immunosuppression start. These characteristics include a wide variety of risk factors for potential infection ranging from country of origin and travel history to history of immunosuppression, to certain comorbid conditions, and to diet and occupation. Increased mobility and medical complexity of transplant patients, and the changing epidemiology of pathogen distribution, can...
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This chapter is a review of rare yet clinically relevant viral encephalitides that have been transmitted from organ donors to recipients. We will discuss the potential pitfalls in diagnosing and managing these illnesses and also discuss the challenges and next steps to better outcomes from these infections.
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Infections are an important cause of morbidity and mortality after transplantation. Some of these infections are environmental and geographically or seasonally important. West Nile virus is one such infection, tied to the epidemiology of infected mosquitos which varies over time. It can cause disease for a transplant recipient either from direct inoculation from an infected mosquito or as a donorderived infection. This chapter reviews current data about the epidemiology of West Nile virus,...
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Donor-derived infections in solid organ transplantation can be prevented by risk stratification of donors based on available information, and inquiries surrounding possible or diagnosed infection are common questions posed to transplant infectious disease subspecialists. This article outlines the five key steps in addressing a donor call from a transplant team in a systematic approach, focusing on donor and recipient-specific factors, transmissibility and treatment of possible infections,...
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Despite clinical and laboratory screening of potential donors for transmissible disease, unexpected transmission of disease from donor to recipient remains an inherent risk of organ transplantation. The Disease Transmission Advisory Committee (DTAC) was created to review and classify reports of potential disease transmission and use this information to inform national policy and improve patient safety. From January 1, 2008 to December 31, 2017, the DTAC received 2185 reports; 335 (15%) were...
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Cryptococcus species can cause serious life-threatening infection in solid organ transplant recipients by reactivation of prior infection, post-transplant 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...
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Hepatitis B virus (HBV) can be transmitted from organ donor to recipient, but details of transmission events are not widely published. The Disease Transmission Advisory Committee (DTAC) evaluated 105 cases of potential donor derived transmission events of HBV between 2009-2017. Proven, probable or possible transmission of HBV occurred in 25 (23.8%) cases. Recipients of liver grafts were most commonly infected (20 of 21 exposed recipients) compared to 9 of 21 exposed non-hepatic recipients....
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