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1.
Transpl Infect Dis ; 21(4): e13115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102550

RESUMO

BACKGROUND: Between 2002 and 2013, the organs of 13 deceased donors with infectious encephalitis were transplanted, causing infections in 23 recipients. As a consequence, organs from donors showing symptoms of encephalitis (increased probability of infectious encephalitis (IPIE) organs) might be declined. We had previously characterized the risk of IPIE organs using data available to most transplant teams and not requiring special diagnostic tests. If the probability of infection is low, the benefits of a transplant from a donor with suspected infectious encephalitis might outweigh the risk and could be lifesaving for some transplant candidates. METHODS: Using organ transplant data and Cox Proportional Hazards models, we determined liver donor and recipient characteristics predictive of post-transplant or waitlist survival and generated 5-year survival probability curves. We also calculated expected waiting times for an organ offer based on transplant candidate characteristics. Using a limited set of actual cases of infectious encephalitis transmission via transplant, we estimated post-transplant survival curves given an organ from an IPIE donor. RESULTS: 54% (1256) of patients registered from 2002-2006 who died or were removed from the waiting list because of deteriorated condition within 1 year could have had an at least marginal estimated benefit by accepting an IPIE liver with some probability of infection, with the odds increasing to 86% of patients if the probability of infection was low (5% or less). Additionally, 54% (1252) were removed from the waiting list prior to their estimated waiting time for a non-IPIE liver and could have benefited from an IPIE liver. CONCLUSION: Improved allocation and utilization of IPIE livers could be achieved by evaluating the patient-specific trade-offs between (a) accepting an IPIE liver and (b) remaining on the waitlist and accepting a non-IPIE liver after the estimated waiting time.


Assuntos
Encefalite Infecciosa , Transplante de Fígado/efeitos adversos , Modelos Teóricos , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/normas , Humanos , Transplante de Fígado/mortalidade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Taxa de Sobrevida
2.
Transpl Infect Dis ; 20(5): e12933, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29809311

RESUMO

BACKGROUND: There were 13 documented clusters of infectious encephalitis transmission via organ transplant from deceased donors to recipients during 2002-2013. Hence, organs from donors diagnosed with encephalitis are often declined because of concerns about the possibility of infection, given that there is no quick and simple test to detect causes of infectious encephalitis. METHODS: We constructed a database containing cases of infectious and non-infectious encephalitis. Using statistical imputation, cross-validation, and regression techniques, we determined deceased organ donor characteristics, including demographics, signs, symptoms, physical exam, and laboratory findings, predictive of infectious vs non-infectious encephalitis, and developed a calculator which assesses the risk of infection. RESULTS: Using up to 12 predictive patient characteristics (with a minimum of 3, depending on what information is available), the calculator provides the probability that a donor may have infectious vs non-infectious encephalitis, improving the prediction accuracy over current practices. These characteristics include gender, fever, immunocompromised state (other than HIV), cerebrospinal fluid elevation, altered mental status, psychiatric features, cranial nerve abnormality, meningeal signs, focal motor weakness, Babinski's sign, movement disorder, and sensory abnormalities. CONCLUSION: In the absence of definitive diagnostic testing in a potential organ donor, infectious encephalitis can be predicted with a risk score. The risk calculator presented in this paper represents a prototype, establishing a framework that can be expanded to other infectious diseases transmissible through solid organ transplantation.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Seleção do Doador/normas , Encefalite Infecciosa/epidemiologia , Transplante de Órgãos/efeitos adversos , Doadores de Tecidos/estatística & dados numéricos , Adulto , Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Feminino , Humanos , Encefalite Infecciosa/etiologia , Encefalite Infecciosa/prevenção & controle , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Transplante de Órgãos/métodos , Medição de Risco/métodos , Adulto Jovem
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