Benamu Esther, Wolfe Cameron R, Montoya José G
aDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California bDivision of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Curr Opin Infect Dis. 2017 Aug;30(4):329-339. doi: 10.1097/QCO.0000000000000377.
Solid organ demand far exceeds organ supply. Strategies to increase the donor pool include the liberalization of selection criteria without increasing the risk of unexpected donor-derived infection (DDI), a rare complication of transplantation carrying high morbidity and mortality. We review the challenging aspects in the prevention of DDI, focusing on the complexities of data sharing and efficient communication and the role infectious diseases specialists play in the process.
Advances in donor screening, transmission recognition and reporting allow for a better estimation of the risk of DDI. However, there is great variability in the frequency and methods with which organ procurement organizations report transmission events.Moreover, the Scientific Registry of Transplant Recipients provides limited donor and recipient outcome infectious diseases related data. Infectious disease contribution to the allocation process has been found to improve organ donation efficiency and communication between involved parties. Although communication gaps are strongly associated with infection transmission (relative risk 2.36%, confidence interval 1.48-3.78), effective communication minimizes or prevents infection in transplant recipients (X(1) 13.13, P = 0.0003).
Prospective research is still required to define optimal screening protocols and further prevent transmission of infection. A holistic approach is likely to result in enhanced transplantation safety. Toward this goal, development of standards of investigation; improvement in reporting and data sharing; and strategies ensuring coordinated and rapid communication among parties involved in the allocation process need to be pursued.
实体器官的需求远远超过器官供应。增加供体库的策略包括放宽选择标准，同时不增加意外供体源性感染（DDI）的风险，DDI是一种罕见的移植并发症，具有高发病率和死亡率。我们回顾了预防DDI方面的挑战，重点关注数据共享和有效沟通的复杂性以及传染病专家在这一过程中所起的作用。
供体筛查、传播识别和报告方面的进展有助于更好地评估DDI风险。然而，器官获取组织报告传播事件的频率和方法存在很大差异。此外，移植受者科学注册系统提供的与供体和受者结局相关的传染病数据有限。已发现传染病专家参与分配过程可提高器官捐赠效率并改善相关各方之间的沟通。尽管沟通差距与感染传播密切相关（相对风险2.36%，置信区间1.48 - 3.78），但有效的沟通可将移植受者的感染降至最低或预防感染（X(1) 13.13，P = 0.0003）。
仍需要进行前瞻性研究来确定最佳筛查方案并进一步预防感染传播。采用整体方法可能会提高移植安全性。为实现这一目标，需要制定调查标准；改进报告和数据共享；并采取策略确保分配过程中各方之间进行协调和快速沟通。
