Background: Differentiating donor-derived infection (DDI) from other causes of illness after solid organ transplantation (SOT) can be challenging. Early recognition of potential DDI allows treatment/prevention of other recipients from the same donor. We reviewed OPTN Ad Hoc Disease Transmission Advisory committee (DTAC) records of all reports classified as proven/probable DDI since 2008 to determine time to presentation by infection type.

Methods: DTAC records of all proven/probable DDI from 2008 to 3/2012 were reviewed and the interval from transplant to recognition of DDI was determined.

Results: 217 recipients from 76 donors were reviewed. In 106 recipients from 72 donors, a determination of proven or probable DDI in the recipient and time to presentation could be made. Among those, 59% of infections presented within 30 days; 77% by day 90. Fungal and bacterial infections presented earliest (median days to presentation: bacterial 14, fungal 18, viral 56, parasitic 57, mycobacterial 67). Of 10 late (>180 days) infection, 8 were viral hepatitis, 1 aspergillus, and 1 Chagas disease. No bacterial infection presented after day 45, and only two fungal infections (cryptococcus, aspergillus) after day 90. 39% of parasitic diseases and 33% of mycobacterial disease presented after 90 days.

Conclusion: While most DDI present in the first 90 days after transplantation, clinicians should be aware that pathogens with extended periods of clinical latency (e.g. Chagas disease, MTB, viral hepatitis) may have a prolonged interval from transplant to clinical presentation.

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