Living donor passes HIV infection to kidney transplant patient

In the first documented case in the U.S. since 1985, a living organ donor transmitted HIV to a New York kidney transplant patient in 2009.

Federal health regulators are calling for new procedures for all living donors to go for a repeat HIV screening no longer than seven days before their organs are recovered and transplanted.

The Centers for Disease Control and Prevention (CDC) spokeswoman Claudia Hutton stated, "Now that we've seen this can happen, it's reasonable to inform the transplant centers to do a second round of tests on donors a week or less before surgery.”

Although, the kidney donor had been earlier diagnosed with syphilis and a history of sex with multiple male partners, the initial laboratory screening 79 days before the transplant showed no evidence of HIV infection.

Initial screening 79 days before transplant
In this specific case, an adult with kidney failure received the kidney transplant at a New York City hospital in 2009 and was then diagnosed with HIV a year later.

Since, the recipient had not engaged in any behaviour that would elevate the risk of infection, it was confirmed that HIV was contracted through transplantation of the kidney from the living donor.

The renal failure patient did not have a history of sexually transmitted infections, injection drug abuse, sex with injection drug users, or other high-risk sexual activity.

Also, he had tested negative for HIV by enzyme immunoassay 12 days before the transplant.

Although, the kidney donor had been earlier diagnosed with syphilis and a history of sex with multiple male partners, the initial laboratory screening 79 days before the transplant showed no evidence of HIV infection.

Retrospective analysis of stored blood samples
Following the kidney transplant surgery, the recipient suffered from bouts of fever, episodes of renal insufficiency and was fraught with fears of organ rejection.

The renal failure patient was admitted to the hospital on day 375 of the transplant for refractory oral and esophageal candidiasis and tested positive for HIV.

Meanwhile, the kidney donor sought screening for sexually transmitted infections a year after the transplant and tested positive for the HIV virus.

The CDC then analyzed the stored blood sample using nucleic acid testing (NAT), the most sensitive test for the virus which can detect an HIV infection within eight to ten days.

The analysis revealed that though the donor was HIV-negative 57 days prior to the transplant, he was positive 11 days before.

On the other hand, the recipient was negative 11 days before the surgery, but tested positive for HIV virus 12 days after the procedure.

The authors of the case study stated, "This case highlights the need to revise national policy on the type and timing of HIV tests used to screen living donors.

"Specifically, transplant centers should screen living donors using the most sensitive test -- currently nucleic acid testing (NAT) -- as close to the time of transplant surgery as feasible.

"Donors should also be counseled to avoid behaviors that place them at risk of acquiring HIV because even the most sensitive HIV test can miss recent infections."

The report is published in the March 18 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.