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Title: Herpes simplex virus-2 transmission following solid organ transplantation: Donor-derived infection and transplantation from prior organ recipients
Austin Authors: Macesic, Nenad;Abbott, Ian J;Kaye, Matthew;Druce, Julian;Glanville, Allan R;Gow, Paul J ;Hughes, Peter D;Korman, Tony M;Mulley, William R;O'Connell, Phillip J;Opdam, Helen;Paraskeva, Miranda;Pitman, Matthew C;Setyapranata, Stella;Rawlinson, William D;Johnson, Paul D R 
Affiliation: Infectious Diseases
Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
Victorian Liver Transplant Unit
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
Monash Infectious Diseases, Monash University, Monash Health, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Nephrology, Monash Health, Melbourne, Victoria, Australia
National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
DonateLife, Melbourne, Victoria, Australia
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Serology and Virology Division (SAViD), South Eastern Area Laboratory Services, and University of NSW, Sydney, NSW, Australia
Issue Date: Oct-2017
Date: 2017-06-15
Publication information: Transplant Infectious Disease 2017; 19(5): e12739
Abstract: BACKGROUND: Owing to limited availability of donor organs, previous solid organ transplant (SOT) recipients are increasingly considered as potential organ donors. We report donor-derived transmission of herpes simplex virus type-2 (HSV-2) to two clusters of SOT recipients with transmission from the original donor and an HSV-2-infected recipient who subsequently became a donor. METHODS: We reviewed medical records of the donors and recipients in both clusters. Pre-transplant serology and virological features of HSV-2 were characterized. Genotyping of HSV-2 isolates to determine potential for donor transmission of HSV-2 through transplantation of organs from prior organ recipients was performed. RESULTS: A kidney-pancreas recipient died day 9 post transplant. Following confirmation of brain death, the lungs and recently transplanted kidney were donated to two further recipients. The liver was not retrieved, but biopsy confirmed HSV-2 infection. Testing on the original donor showed negative HSV-2 polymerase chain reaction and HSV immunoglobulin (Ig)M, but positive HSV-2 IgG. The liver recipient from the original donor developed HSV-2 hepatitis and cutaneous infection that responded to treatment with intravenous acyclovir. In the second cluster, lung and kidney recipients both developed HSV-2 viremia that was successfully treated with antiviral therapy. Genotyping of all HSV-2-positive samples showed 100% sequence homology for three recipients. CONCLUSIONS: Donor-derived HSV infection affected two clusters of recipients because of transplantation of organs from a prior organ recipient. HSV should be considered as a possible cause of illness in febrile SOT recipients in the immediate post-transplant period and may cause disseminated disease and re-infection in HSV-2-seropositive recipients. Testing of HSV serology and prophylaxis may be considered in SOT recipients not receiving cytomegalovirus prophylaxis.
DOI: 10.1111/tid.12739
ORCID: 0000-0002-7905-628X
Journal: Transplant Infectious Disease
PubMed URL:
Type: Journal Article
Subjects: Allograft re-use
Donor-derived infection
Hepatitis herpes simplex virus
Appears in Collections:Journal articles

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