*Purpose: 37-41% of deceased donors in Region I are considered “PHS increased risk for infectious disease transmission” (IR) individuals, our Center developed guidelines for the utilization of these donors and implemented a system to track follow-up testing for possible disease transmission. We reviewed our Center’s 7-year experience utilizing these donor organs and tracking program.

*Methods: MGH Transplant Infectious Disease Program developed a protocol based on the PHS Guidelines to guide the Transplant Center in the management of recipients of organs from designated PHS-IR donors. Recipients of these donor organs had blood testing (serology and viral load) for human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses performed on the day of transplant, 1-3 months after transplant, and 6-12 months after transplant. A Quality Assessment and Performance Improvement audit was implemented to ensure medical record documentation and that follow-up testing was conducted and any required care was implemented.

*Results: From January 2013 to December 2019 there were 559 organ donor transplants performed from PHS-IR donors (91 heart, 68 lung, 173 liver, 223 kidney, 3 kidney-pancreas, 1 pancreas). Of these 554 were deceased donors and 5 were living kidney donors similarly designated as PHS-IR. A retrospective analysis of follow-up testing for the above recipients demonstrated the following:

• 1 heart recipient was found to be HCV viral load positive after transplant (not believed to be donor-derived based on re-testing).

17 lung recipients (25%) converted their HBV core antibody status from negative to positive at 1-3 months after surgery. Of these 17 patients, 10 patients then converted HBV core antibody back to negative; 5 patients are pending follow-up testing; and 2 patients expired prior to follow-up testing. 1 lung recipient was also found to have a false positive HIV antibody test in follow-up testing.6 liver recipients were found to be HBV DNA positive after transplant. Of these 6 patients, 2 patients had low HBV DNA levels with repeat testing negative; 1 recipient was HBV core antibody positive pre-transplant and was not on NRTI after transplant; 1 recipient was HBV core antibody positive pretransplant and had 1 positive HBV DNA after transplant with repeat testing negative; and 2 were believed to be donor-derived. Of note 3 of the 6 recipients received liver/kidney transplants and 3 recipients received known HCV-positive donor organs, were treated with DAA with subsequent HBV DNAemia 3-4 months later.1 kidney recipient was noted to have a HIV RNA PCR below the linear quantitative range but reported as detected and is pending repeat viral load and antibody/antigen testing.

*Conclusions: Our Center experience demonstrates that PHS increased risk for transmission of infection donors may be used safely when coupled with meticulous tracking of recipients. HBV reactivation may be observed following DAA therapy for HCV.

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