Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Transpl Infect Dis. 2024 Nov;26 Suppl 1:e14356. doi: 10.1111/tid.14356. Epub 2024 Aug 16.
Donor-derived dengue infections present significant challenges to organ transplantation, particularly in endemic regions like Singapore. Although primarily transmitted by Aedes mosquitoes, dengue can also be transmitted through organ transplantation, occasionally with fatal outcomes. This study aims to evaluate the outcomes and evolution of dengue screening protocols for potential deceased donors in Singapore from 2006 to 2022.
Initially, screening was done via dengue immunoglobulin M (IgM), targeting donors with specific clinical criteria (thrombocytopenia, drop in platelet count, prolonged prothrombin time/partial thromboplastin time, and discretion of the transplant team), later transitioning to blood dengue reverse transcription-polymerase chain reaction (RT-PCR) in 2007 with similar criteria, and subsequently universal screening in 2016. In 2021, urine dengue RT-PCR was added following a case of donor-derived dengue infection from an aviremic but viruric donor.
Out of 431 potential deceased donors, 395 (91.6%) underwent dengue screening, with six (1.5%) testing positive for dengue. In 2006, three positive screens were identified: two through dengue IgM and one via blood dengue RT-PCR; subsequent years saw one positive screen each in 2007, 2008, and 2019 via blood dengue RT-PCR. Potential deceased donors with a positive blood dengue screen were rejected as solid organ and tissue donors. Those with negative blood dengue RT-PCR but positive urine dengue RT-PCR would be rejected as kidney donors, but the use of other organs and tissues was at the discretion of the transplantation team.
The optimal screening protocol remains uncertain, but our findings suggest that a universal screening strategy utilizing both blood and urine dengue RT-PCR could be considered in dengue-endemic countries.
供体源性登革热感染对器官移植构成重大挑战，特别是在新加坡等流行地区。虽然登革热主要通过埃及伊蚊传播，但也可通过器官移植传播，偶尔会导致致命后果。本研究旨在评估 2006 年至 2022 年新加坡潜在已故供体的登革热筛查方案的结果和演变。
最初，通过登革热免疫球蛋白 M（IgM）进行筛查，针对具有特定临床标准的供体（血小板减少症、血小板计数下降、延长的凝血酶原时间/部分凝血活酶时间和移植团队的酌情处理），随后于 2007 年过渡到具有类似标准的血液登革热逆转录-聚合酶链反应（RT-PCR），随后于 2016 年进行普遍筛查。2021 年，在一名无病毒血症但病毒血症的供体中发生供体源性登革热感染后，增加了尿液登革热 RT-PCR 筛查。
在 431 名潜在已故供体中，有 395 名（91.6%）接受了登革热筛查，其中 6 名（1.5%）检测出登革热阳性。2006 年，发现 3 个阳性筛查结果：2 个通过登革热 IgM，1 个通过血液登革热 RT-PCR；随后的几年中，2007 年、2008 年和 2019 年各有 1 个阳性筛查结果通过血液登革热 RT-PCR 检测到。具有阳性血液登革热筛查结果的潜在已故供体被拒绝作为实体器官和组织供体。那些血液登革热 RT-PCR 阴性但尿液登革热 RT-PCR 阳性的供体将被拒绝作为肾脏供体，但其他器官和组织的使用由移植团队决定。
最佳筛查方案仍不确定，但我们的研究结果表明，在登革热流行国家，可以考虑使用血液和尿液登革热 RT-PCR 的通用筛查策略。
