Background: Donor-derived Toxoplasmosis (DDT) is uncommon, but outcomes may be poor. Donor risk factors are difficult to recognize, and donor screening is not currently universally required. Potential donor-derived transmission events (PDDTE) reported to DTAC are reviewed and classified according to disease transmission likelihood. To better understand transmission of Toxoplasma and to consider mitigation strategies, we analyzed all toxoplasmosis cases reviewed by DTAC.

Methods: 14 cases were reviewed by the DTAC between 1/2008 and 9/2015. DDT was diagnosed based on compatible serology, histology, and/or pathology findings in the donor or recipient.

Results: Proven or probable (p/p) donor derived toxoplasmosis developed in 11 organ recipients from 10 donors not known to be toxoplasmosis positive a time of transplant. In 4 reports, toxoplasmosis was detected in the donor as a result of OPO or recipient center donor testing; these resulted in no transmission events. Transmissions were reported in 6 heart recipients as well as 5 non-heart recipients (including liver, kidney, and lung recipients). The median time from transplant to clinical infection was 36 days (IQR 20-85). 5/11 (45%) infected recipients died of their infection; in 3 cases toxoplasmosis was only identified at autopsy, and 25% (2/8) of recipients died despite toxoplasmosis being recognized pre-mortem. Half of these p/p donors had significant travel outside of the United States. Communication issues contributed to poor outcomes in 3 of the infections in non-cardiac recipients.

Conclusion: While the potential for DDT to occur in heart recipients is well appreciated, our data suggests that DDT may be more common than previously appreciated in non-heart recipients. This finding, as well as the communication issues that arise when donor testing is performed at the transplant center rather than by the OPO, need to be considered when developing policy and best practices regarding donor testing for toxoplasmosis.

CITATION INFORMATION: Wolfe C, Wilk A, Tlusty S, Sifri C, Morris M, Mehta A, Kaul D. Donor-Derived Toxoplasmosis in Solid Organ Transplant 2008 – 2015: Opportunities for Improvement. Am J Transplant. 2016;16 (suppl 3).

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