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Donor infections limiting lung transplantation

Donor infections limiting lung transplantation
Donors should not be used routinely upon evidence of:
  • Inadequately treated bacteremia or pneumonia with multidrug-resistant organisms
  • Any mycobacterial infection of the lungs
  • Invasive fungal disease
  • Hepatitis B surface antigen-positivity
  • HIV infection with detectable viral load*
  • Creutzfeldt-Jakob disease
  • West Nile virus
  • Severe acute respiratory syndrome (SARS), SARS-CoV-2 infection
  • History of travel to a Zika-endemic area in the previous 28 days or symptoms of Zika infection in prior six months associated with travel to an endemic area
Donor lungs may be used with caution/specific treatment upon evidence of:
  • Gram-positive or gram-negative bacteremia with susceptible pathogens
  • Mycobacterial infections outside the chest
  • Fungal airway colonization
  • Hepatitis B core antibody positive, negative NAT
  • Hepatitis C infection with positive NAT
  • Extrapulmonary herpesviruses (HHV 6-8, simplex, varicella)
  • Cytomegalovirus (CMV) seropositivity
  • Epstein-Barr virus (EBV)Δ
  • Protozoan or helminthic infections (eg, Trypanosoma cruzi, strongyloides)

HIV: human immunodeficiency virus; nucleic acid testing (NAT); HHV: human herpes virus.

* Lungs from HIV-positive donors may be considered for HIV-positive recipients only.

¶ Risk of recipient CMV disease has been markedly reduced with routine CMV prophylaxis. Ongoing close monitoring is appropriate for seronegative recipients who receive lung allograft from CMV seropositive donor.

Δ EBV seronegative recipients who receive lung allografts from EBV seropositive donors are at increased risk for post-transplant lymphoproliferative disease. Post-transplant EBV viral load monitoring may be appropriate in this setting, but serologic mismatch is generally not considered a contraindication for lung transplant.

Adapted from: The Journal of Heart and Lung Transplantation, Vol. 24, Garrity ER Jr, Boettcher H, Gabbay E, Donor infection: an opinion on lung donor utilization, 791-797, Copyright © 2005, with permission from the The International Society for Heart and Lung Transplantation.

Updated with data from:

  1. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40:1349.
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