Shingde Rashmi, Habachou L Ines, Calisa Vaishnavi, Craig Jonathan C, Tong Allison, Chen Sharon C-A, Wong Germaine
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Transpl Infect Dis. 2018 Apr;20(2):e12851. doi: 10.1111/tid.12851. Epub 2018 Mar 6.
Unexpected donor-derived transmission of infections is rare, but is associated with significant morbidity and mortality. We aimed to provide an overview of published cases on unexpected infectious transmissions.
We systematically reviewed all published evidence describing any unexpected donor-derived viral, bacterial, fungal, and parasitic infections in kidney transplant recipients.
In all, 119 studies (case reports [n = 36], case series [n = 78], cohort studies [n = 2], and case-control studies [n = 3]) involving 139 donors and 207 kidney recipients were included. Donor-derived viral (n = 116, 56.0%) infections were most prevalent, followed by bacterial (32, 15.5%), fungal (32, 15.5%), and parasitic (27, 13.0%) infections. The most commonly reported viral infections were human immunodeficiency virus (HIV) (n = 20, 9.7%), human T-cell lymphotrophic virus (HTLV) (n = 20, 9.7%), and West Nile virus (WNV) (n = 13, 6.3%). The most frequent bacterial infections were caused by Mycobacterium tuberculosis (10, 4.8%) and Pseudomonas aeruginosa (9, 4.3%). Candida species were the most frequent causes of fungal donor-derived infections (8, 3.9%). Toxoplasma gondii accounted for seven (3.4%) cases of transmitted parasitic infections. Patients with rabies experienced the highest probability of recipient death from virus-related complications at 90.0%, within a median time of 2.8 months after transplantation.
The frequency of donor-derived infectious transmission appears low in kidney transplantation, with viral transmissions being most commonly reported overall.
供体意外传播感染虽罕见，但与显著的发病率和死亡率相关。我们旨在概述已发表的关于意外感染传播病例的情况。
我们系统回顾了所有已发表的描述肾移植受者中任何意外的供体源性病毒、细菌、真菌和寄生虫感染的证据。
总共纳入了119项研究（病例报告[n = 36]、病例系列[n = 78]、队列研究[n = 2]和病例对照研究[n = 3]），涉及139名供体和207名肾移植受者。供体源性病毒感染（n = 116，56.0%）最为普遍，其次是细菌感染（32例，15.5%）、真菌感染（32例，15.5%）和寄生虫感染（27例，13.0%）。最常报告的病毒感染是人类免疫缺陷病毒（HIV）（n = 20，9.7%）、人类T细胞嗜淋巴细胞病毒（HTLV）（n = 20，9.7%）和西尼罗河病毒（WNV）（n = 13，6.3%）。最常见的细菌感染由结核分枝杆菌（10例，4.8%）和铜绿假单胞菌（9例，4.3%）引起。念珠菌属是供体源性真菌感染最常见的原因（8例，3.9%）。弓形虫导致7例（3.4%）传播性寄生虫感染。狂犬病患者因病毒相关并发症导致受者死亡的概率最高，为90.0%，中位时间为移植后2.8个月。
肾移植中供体源性感染传播的频率似乎较低，总体上病毒传播报告最为常见。
