2013年供体源性传播事件：器官获取与移植网络特设疾病传播咨询委员会报告
Donor-derived transmission events in 2013: a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee.
作者信息
Green Michael, Covington Shandie, Taranto Sarah, Wolfe Cameron, Bell Walter, Biggins Scott W, Conti David, DeStefano G David, Dominguez Edward, Ennis Donna, Gross Thomas, Klassen-Fischer Mary, Kotton Camille, LaPointe-Rudow Dianne, Law Yuk, Ludrosky Kristen, Menegus Marilyn, Morris Michele I, Nalesnik Michael A, Pavlakis Martha, Pruett Timothy, Sifri Costi, Kaul Daniel
机构信息
1 Division of Pediatric Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA. 2 United Network for Organ Sharing, Richmond, VA. 3 Division of Transplant Infectious Disease, Duke University Medical Center, Durham, NC. 4 Division of Anatomic Pathology, University of Alabama, Birmingham, AL. 5 Division of Gastroenterology, University of Colorado, Aurora, CO. 6 Department of Transplant Surgery, Albany Medical College, Albany, NY. 7 Lifesharing, San Diego, CA. 8 Division of Infectious Disease, Methodist Dallas Medical Center, Dallas, TX. 9 Transplant Clinical Operations, Indiana University Hospital, Indianapolis, IN. 10 Center for Global Health, National Cancer Institute, Rockville, MD. 11 Joint Pathology Center, Silver Spring, MD. 12 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA. 13 Mount Sinai Medical Center, New York, NY. 14 Division of Cardiac Transplant, Seattle Children's Hospital, Seattle, WA. 15 Cleveland Clinic, Cleveland, OH. 16 Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY. 17 Division of Internal Medicine, University of Miami Hospital, Miami, FL. 18 Division of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA. 19 Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA. 20 Division of Transplantation, University of Minnesota Medical Center, Minneapolis, MN. 21 Division of Infectious Diseases, University of Virginia Health System, Charlottesville, VA. 22 Division of Infectious Diseases, University of Michigan Medical Center, Ann Arbor, MI.
出版信息
Transplantation. 2015 Feb;99(2):282-7. doi: 10.1097/TP.0000000000000584.
BACKGROUND
The Organ Procurement Transplant Network Disease Transmission Advisory Committee (DTAC), a multidisciplinary committee, evaluates potential donor-derived transmission events (PDDTE), including infections and malignancies, to assess for donor transmitted events.
METHODS
Reports of unexpected PDDTE to Organ Procurement Transplant Network in 2013 were fully reviewed by DTAC. A standardized algorithm was used to assess each PDDTE from a given donor and to classify each individual recipient from that donor.
RESULTS
Of 443 total PDDTE submitted, 159 were triaged and not sent out to the full DTAC. Of 284 fully evaluated reports, 32 (11.3%) resulted in a proven/probable (P/P) transmission of infection, malignancy or other conditions to 42 recipients. Of 204 infection events, 24 were classified as P/P affecting 30 recipients, with four deaths. Bacteria were the most frequently reported type of infection, accounting for 99 reports but only 12 recipients from 11 donors experienced P/P transmission. There were 65 donors reported with potential malignancy events and 5 were classified as P/P transmissions with 8 affected recipients and 2 deaths. Additionally, there were 16 noninfection, nonmalignancy reports resulting in 3 P/P transmissions to 4 recipients and 1 death.
CONCLUSIONS
There was a 43% increase in the number of PDDTE reported and reviewed in 2013 over 2012. However, the percent with P/P transmission remains low, affecting recipients from 32 donors especially when compared with the more than 14,000 donors recovered annually in the United States. The continued use of the new standard algorithm and triaging process will enhance the reproducibility of DTAC assessments and allow more robust analysis of our aggregate DTAC experience.
背景
器官获取与移植网络疾病传播咨询委员会（DTAC）是一个多学科委员会，负责评估潜在的供体源性传播事件（PDDTE），包括感染和恶性肿瘤，以评估供体传播事件。
方法
DTAC对2013年向器官获取与移植网络报告的意外PDDTE进行了全面审查。使用标准化算法评估来自给定供体的每个PDDTE，并对该供体的每个个体受者进行分类。
结果
在提交的443个PDDTE中，159个被分流，未发送给整个DTAC进行评估。在284份经过全面评估的报告中，32份（11.3%）导致感染、恶性肿瘤或其他疾病被证实/可能（P/P）传播给42名受者。在204起感染事件中，24起被归类为P/P，影响30名受者，其中4人死亡。细菌是最常报告的感染类型，占99份报告，但只有来自11名供体的12名受者经历了P/P传播。有65名供体报告了潜在的恶性肿瘤事件，5起被归类为P/P传播，8名受者受到影响，2人死亡。此外，有16份非感染、非恶性肿瘤报告导致3起P/P传播给4名受者，1人死亡。
结论
2013年报告和审查的PDDTE数量比2012年增加了43%。然而，P/P传播的比例仍然很低，影响了来自32名供体的受者，特别是与美国每年超过14000名恢复的供体相比。继续使用新的标准算法和分流程序将提高DTAC评估的可重复性，并允许对我们DTAC的总体经验进行更有力的分析。
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