immunocompromised hosts and transplant recipients
TRANSCRIPT
05/01/2023
Immunocompromised hosts and transplant recipientsPeter V. Chin-Hong, MD
05/01/20232
The population
Immunocompromised patients• HIV/AIDS• Stem cell transplant recipients• Organ transplant recipients• Biologics
Donors• Organ donors (live and
deceased)• Tissue donors (live and
deceased)
Zika virus rash
05/01/20233
The population
Immunocompromised patients• HIV/AIDS• Stem cell transplant
recipients• Organ transplant recipients• Biologics
Donors• Organ donors (live and
deceased)• Tissue donors (live and
deceased)
Zika virus rash
05/01/20234
Immunocompromised (IC) patients: ClinicalPathogen Transmiss
ionClinical: general
Clinical:neuro
IC
Zika Flavivirus Aedes aegyptusAedes albopictus mosquito
Fever, rash, arthralgia, conjunctivitis
MicrocephalyIntracranial calcificationsGuillain-Barré
No known increase in severity (yet)
Dengue Flavivirus Aedes aegyptusAedes albopictus mosquito
High fever, severe myalgia, headache. No conjunctivitis
Encephalitis, seizures (1%)
>40 published cases including fatal cases. No known increase in severity
Chikungunya Flavivirus Aedes aegyptusAedes albopictus mosquito
High fever, severe arthralgia. No conjunctivitis
Encephalitis, Guillain-Barré
Published cases in transplant. No known increase in severity
05/01/20235
Immunocompromised (IC) patients: ClinicalPathogen Transmiss
ionClinical: general
Clinical:neuro
IC
Zika Flavivirus Aedes aegyptusAedes albopictusmosquito
Fever, rash, arthralgia, conjunctivitis
MicrocephalyCalcificationsFetal demiseGuillain-Barré
No known increase in severity (yet)
West Nile Virus
Flavivirus Culex mosquito
Fever, rash, myalgia, headache. No conjunctivitis
Meningitis, Encephalitis, Flaccid paralysis
Increased neuro-invasive disease
Cytomegalovirus (CMV)
Herpesvirus Close contact, sexual, blood or tissue, perinatal exposure
Mono-like illness, hepatitis
MicrocephalyCalcificationsFetal demiseEncephalitis, Guillain-Barré
Common and life threateningMono-like illness, hepatitis, retinitis, colitis, pneumonitis
05/01/20236
The population
Immunocompromised patients• HIV/AIDS• Stem cell transplant recipients• Organ transplant recipients• Biologics
Donors• Organ donors (live and
deceased)• Tissue donors (live and
deceased)
Zika virus rash
05/01/20237
Patient safety following organ and tissue transplantation OPTN Policy 15.3: Informed Consent of
Transmissible Disease Risk
• The Host OPO (for deceased organ donors) and the Procuring Center (for live organ donors) must obtain the donor’s medical/behavioral history
• If the donor meets Current PHS Criteria for being at
Increased Risk of Transmitting HIV, HBV or HCV
There is a recognized disease present in the donor that, in the opinion of the transplant center, be transmitted to the recipient
o Special informed consent must be obtained
o Follow-up testing and treatment must be offered to the transplant recipient
Potential donor derived transmission events
2013 = 443
05/01/20238
Guidelines for donor screening to reduce transmission of Zika Virus
Regulatory body Guidelines issued
Medical & Social History
Exclude as donor if:
Human cells and tissues
FDA FDA 3/1/16 Screen for Zika -Zika diagnosed in past 6 months (live and deceased)-Residence in, or travel to Zika area in past 6 months (live)-Sex with male with above risk factors (live)
Organs Organ Procurement and Transplantation Network (OPTN)
OPTN/UNOS/DTAC, AST, ASTS 2/3/16
Screen for Zika: “focus on recent travel history, epidemiologic risk factors, …symptoms” of donor
-Travel to Zika-endemic area in past 28 days and recipient pregnant or of child-bearing age -Donor with active Zika (live)…”Do not believe concern for Zika should…exclude donors”
05/01/2023
The need continues to grow
21 people die each day while waiting for a transplant
122,000 people on waiting list 31,000 organ transplants
performed in 2015 from 15,000 donors
The gap between supply and demand continues to widen
Why be so conservative with Zika screening in organ transplant?
Preparedness for the Zika Virus: A Public Health Emergency
05/01/202310
Zika virus in immunocompromised (IC)
No evidence so far of increased incidence or severity in immunocompromised
Other flaviruses with same vector (Dengue, Chikungunya) have overlap in symptoms except congenital effects, and have no increased severity in IC
Other flavivirus with different vector (WNV) with more neurotropic disease in IC
CMV has interesting parallel to Zika in terms of congenital effects
Zika will result in potentially fewer tissue donations but not organ donations (yet)
Summary
Immunostaining of Flaviviral Antigens in Neurons WNV