The DTAC evaluates unanticipated potential donor-derived transmission events (PDDTE), including mostly infections (I) & malignancies (M), to assess for likelihood of donor transmission. Reporting policy changed significantly in 09/2016 emphasizing recipient disease and limited impactful donor diseases, thereby leading to changing awareness of transmission events.

Methods: Between 7/1/16 – 6/30/17 the OPTN received 269 PDDTE reports; 172 were reviewed by DTAC, down from 212 reviewed in the previous year. A standardized algorithm was used to classify each donor and individual recipients of reported donors.

Results: 35/172 (20%) reported donors had proven or probable (p/p) transmission of I, M or other conditions to recipients (last year 11.3% donor reports resulted in a p/p transmission). 58/115 (50%) recipients from these donors had p/p disease transmission, with 11 reported consequent deaths. Malignancies were the most frequently reported (47) PDDTE, 5 resulting in p/p transmission to 7/17 recipients, 3 fatal. 11/13 living donor reports involved malignancies, yet only 1 transmitted. Bacterial and viral pathogens were each reported in 9 p/p donors, leading to 13/29 and 15/28 organs becoming infected respectively. Kidney recipients had the highest disease penetrance, with 30/49 (61%) affected, mostly viral. Although 21 reports involved HBV/HCV, only 2 involved a viral transmission. "Other" diseases transmitted of note included amoebic encephalitis, nut allergy, hemochromatomsis and amyloidosis.

Conclusion: Unexpected PDDTE are frequently encountered in solid organ transplantation, despite advances in donor assessment. The proportion of p/p cases has risen notably, during a year when reporting requirements focused on recipient disease rather than all positive cultures. Malignancy numbers remain significant, and continue to contribute to mortality amongst recipients with PDDTE.

CITATION INFORMATION: Wolfe C., Tlusty S., Vece G., Bag R., Berry G., Bucio J., Danziger-Isakov L., Florescu D., Goldberg D., Ho C., La Hoz R., Lilly K., Malinis M., Mehta A., Nalesnik M., Sawyer R., Strasfeld L., Wood P., Theodoropoulos N., Michaels M. Donor Derived Transmissions in 2016-2017: Analysis of the OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC) Am J Transplant. 2017;17 (suppl 3).

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