Recommendations for Dengue Screening Protocol for Donors and Recipients in Solid Organ Transplantation

Santos, Daniel Wagner de Castro Lima; Stucchi, Raquel Silveira Bello; Clemente, Wanessa Trindade; Abdala, Edson; Santoro-Lopes, Guilherme; Pierrotti, Ligia Camera

doi:10.53855/bjt.v27i1.588/ENG

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Brazilian Journal of Transplantation

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SPECIAL ARTICLE • Braz. J. Transpl. 27 • 2024 • https://doi.org/10.53855/bjt.v27i1.588/ENG copy

Recommendations for Dengue Screening Protocol for Donors and Recipients in Solid Organ Transplantation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Dengue, an infection characterized by recurrent epidemic spanning 3 to 5 years, stands out as a one of the most prominent problem due to its escalating case number and geographic extension. Despite its vast distribution, the disease occurs most intensely in the Americas and Southeast Asia. Within this scenario, it is imperative to carefully assess the potential repercussions of this epidemic on transplant activity. Although literature on this matter remains sparse, a review of probable and confirmed cases of dengue transmission through infected donors was carried out, addressing clinical characteristics and outcomes in recipients of such organs. Considering the strategies adopted in other countries that have already experienced dengue epidemics with the transmission of the virus through organ transplantation, the Comissão de Infecção em Transplante (COINT) da Associação Brasileira de Transplante (ABTO) delineates a protocol for screening potential donors and transplant candidates. This protocol involves the combined use of NS1/IgM on blood, alongise stringent criteria for evaluating donor and recipient suitability.

Descriptors
Dengue; Communicable Diseases; Organ Transplantation

Reference	Country	Organ/receiver characteristics	Donortype	Symptoms(D1)	Donor/receiversymptoms	Classification	Outcome	Antigen, serology or molecular testing
Saigal et al.¹⁹19 Saigal S, Choudhary NS, Saraf N, Kataria S, Mohanka R, Soin AS. Transmission of dengue virus from a donor to a recipient after living donor liver transplantation. Liver Transpl 2013;19(12):1413-4. https://doi.org/10.1002/lt.23755 https://doi.org/10.1002/lt.23755...	India	Liver/male, 38 years old, cirrhosis due to hepatitis B virus	Alive, son, 19 years old	6	Receiver: D6: fever, thrombocytopenia, severe graft dysfunction (AST > 3,500 and ALT > 2,500)	Classic dengue with warning signs	Alive	Receiver: NS1+ and PCR DENV+ Donor: NS1+ and PCR DENV+
Gupta et al.²⁰20 Gupta RK, Gupta G, Chorasiya VK, Bag P, Shandil R, Bhatia V, et al. Dengue virus transmission from living donor to recipient in liver transplantation: a case report. J Clin Exp Hepatol 2016;6(1):59-61. https://doi.org/10.1016/j.jceh.2016.01.005 https://doi.org/10.1016/j.jceh.2016.01.0...	India	Liver/male, 40 years old, cryptogenic cirrhosis	Alive, brother-in-law, 29 years old	5	Donor: D2-3 post Tx: fever, thrombocytopenia, elevated transaminases. Receiver: D3-6: elevation of transaminases; D5: fever; D7: thrombocytopenia.	Classic dengue without complications	Alive	Donor: NS1+ post-Tx Receiver: NS1+
Rosso et al.²¹21 Rosso F, Pineda JC, Sanz AM, Cedano JA, Caicedo LA. Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review. Braz J Infect Dis 2018;22(1):63-9. https://doi.org/10.1016/j.bjid.2018.01.001 https://doi.org/10.1016/j.bjid.2018.01.0...	Colombia	Liver/male, 53 years old	Deceased, intracranial hemorrhage, SAH	2	Donor: Visited the service with fever and thrombocytopenia one week before death (chart review). Receiver: D2: fever, thrombocytopenia, lymphopenia, anemia, elevated transaminases, transient encephalopathy, liver biopsy with lymphoplasmacytic, neutrophilic infiltrate suggestive of viral disease.	Severe dengue with organ dysfunction	Alive	Donor: IgG+ and IgM+ (retroactive testing on stored blood). Receiver: IgG-; IgM+ and PCR DENV3+.
Rosso et al.²¹21 Rosso F, Pineda JC, Sanz AM, Cedano JA, Caicedo LA. Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review. Braz J Infect Dis 2018;22(1):63-9. https://doi.org/10.1016/j.bjid.2018.01.001 https://doi.org/10.1016/j.bjid.2018.01.0...	Colombia	Heart/male,41 years old, dilated cardiomyopathy	Deceased, intracranial hemorrhage, SAH	3	Donor: Visiting the service with fever and thrombocytopenia one week before death (chart review). Receiver: D3:myalgia, arthralgia, fever, lymphopenia, thrombocytopenia, elevation of transaminases, bilirubin and alkaline phosphatase; D16: severe thrombocytopenia, shock and cardiac tamponade (hemorrhagic pericardial effusion).	Severe dengue fever with organ dysfunction and hemorrhage	Alive	Donor: IgG+ and IgM+ (retroactive testing on stored blood). Receiver: IgG -; IgM+ and PCR DENV3+.
Rosso et al.²¹21 Rosso F, Pineda JC, Sanz AM, Cedano JA, Caicedo LA. Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review. Braz J Infect Dis 2018;22(1):63-9. https://doi.org/10.1016/j.bjid.2018.01.001 https://doi.org/10.1016/j.bjid.2018.01.0...	Colombia	Kidney/female,31 years old	Deceased, head trauma	8	Donor: No reported symptoms. Receiver: D8: fever, vomiting, diarrhea, jaundice, pain in the right iliac fossa, thrombocytopenia; D15: drained perigraft hematoma.	Severe dengue fever with organ dysfunction and hemorrhage	Alive	Donor: NS1+ (retroactive test on stored blood performed for the diagnosis of dengue in this recipient). Receiver: NS1+ and PCR DENV4+
Rosso et al.²¹21 Rosso F, Pineda JC, Sanz AM, Cedano JA, Caicedo LA. Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review. Braz J Infect Dis 2018;22(1):63-9. https://doi.org/10.1016/j.bjid.2018.01.001 https://doi.org/10.1016/j.bjid.2018.01.0...	Colombia	Kidney/female,48 years old	Deceased, head trauma	4	Donor: No reported symptoms. Receiver: D4: fever, anemia; D23: asymptomatic elevationof transaminases.	Classic dengue without complications	Alive	Donor: NS1+ (retroactive test on stored blood carried out following the diagnosis of dengue in the other recipient). Receiver: IgM+; NS1, IgG and PCR DENV negative.
Kumar et al.²²22 Kumar S, Sable S, Yadav K, Sharma S, Chouhan A, Kapoor S, et al. Dengue transmission from donor to recipient after living donor liver transplant. Trop Gastroenterol 2019. https://dx.doi.org/10.7869/tg.497 https://doi.org/10.7869/tg.497...	India	Liver/male, 64 years old, cirrhosis due to non-alcoholic steatohepatitis and hepatitis C virus	Alive, son, 28 years old	4	Donor: D2: fever, anemia, thrombocytopenia; D9: bleeding from the surgical wound. Receiver: D4: thrombocytopenia, elevated transaminases; after D12, he developed upper gastrointestinal bleeding, endotracheal intubation, and acute respiratory distress syndrome.	Severe dengue with multiple organ dysfunction and hemorrhage	Death	Donor: NS1+ Receiver: NS1+; PCR DENV1+, IgG-, IgM-.
Mathew²³23 Mathew JS, Menon VP, Menon VP, Mallick S, Amma BSPT, Balakrishnan D, et al. Dengue virus transmission from live donor liver graft. Am J Transplant 2019;19(6):1838-46. https://doi.org/10.1111/ajt.15270 https://doi.org/10.1111/ajt.15270...	India	Liver/male, 58 years old, alcoholic cirrhosis	Alive, brother,48 years old	9	Donor: D6: fever, thrombocytopenia, abdominal pain. It evolves with ascites, elevated transaminases and encephalopathy. Receiver: D9:abdominal pain, thrombocytopenia, and altered sensorium. He developed encephalitis and kidney and liver dysfunction.	Severe dengue with multiple organ dysfunction	Death	Donor: NS1-; PCR DENV1+, IgG+, IgM+. Receiver: NS1+; PCR DENV1+, IgG-, IgM-.
Lecadieu et al.²⁴24 Lecadieu A, Teysseyre L, Larsen K, Vidal C, Caron M, Traversier N, et al. Case report: transmission of dengue virus from a deceased donor to a kidney transplant recipient previously infected by dengue virus. Am J Trop Med Hyg 2021;104(6):2199-2201. https://doi.org/10.4269/ajtmh.21-0137 https://doi.org/10.4269/ajtmh.21-0137...	France (La Réunion)	Kidney/male, 58 years old, chronic kidney disease due to nephrolithiasis	Deceased, male, 62 years old, head trauma	11	Donor: No reported symptoms. Receiver: D11:anemia, thrombocytopenia, elevated transaminases, hypotension and abdominal pain. Subjected to abdominal wall collection drainage, evolving into hemorrhagic shock.	Severe dengue with multiple organ dysfunction	Alive	Donor: D0: PCR DENV-; IgM+/IgG+ Receiver: D11: PCR DENV1+; D30: IgM+/IgG+.
Lecadieu et al.²⁴24 Lecadieu A, Teysseyre L, Larsen K, Vidal C, Caron M, Traversier N, et al. Case report: transmission of dengue virus from a deceased donor to a kidney transplant recipient previously infected by dengue virus. Am J Trop Med Hyg 2021;104(6):2199-2201. https://doi.org/10.4269/ajtmh.21-0137 https://doi.org/10.4269/ajtmh.21-0137...	France (La Réunion)	Kidney/male,61 years old	Deceased, male, 62 years old, with head trauma	12	Donor: No reported symptoms. Receiver: D12: thrombocytopenia, elevation of transaminases.	Classic dengue without complications	Alive	Donor: D0: PCR DENV-; IgM+/IgG+ Receiver: D12: PCR DENV1+ (sangue)/IgM-/IgG-; D30: PCR DENV- (blood)/PCR DENV+ (urine)/IgM+/Ig+.
Sim et al.²⁵25 Sim JXY, Gan ES, Tan HC, Choy MM, Wong HM, Tan BH, et al. Aviremic organ transplant dengue virus transmission – A case report. Am J Transplant 2021;21(5):1944-7. https://doi.org/10.1111/ajt.16540 https://doi.org/10.1111/ajt.16540...	Singapore	Kidney/male,63 years old,IgA nephropathy	Deceased, female, 26 years old, intracranial hemorrhage	5	Donor: Isolated fever 10 days before brain death (eve of elective cesarean section). She was hospitalized 10 days later with intracranial hemorrhage and brain death. Receiver: D5: fever, thrombocytopenia.	Classic dengue without complications	Alive	Donor: D-10: PCR DENV-;D-10: NS1-; D0: PCR DENV- (blood); D0: PCR DENV+ (urine). Receiver: D0: PCR DENV-/IgG+; D8-14: PCR DENV2+ (blood).
Sim et al.²⁵25 Sim JXY, Gan ES, Tan HC, Choy MM, Wong HM, Tan BH, et al. Aviremic organ transplant dengue virus transmission – A case report. Am J Transplant 2021;21(5):1944-7. https://doi.org/10.1111/ajt.16540 https://doi.org/10.1111/ajt.16540...	Singapore	Kidney/male, 39 years old, glomerulonephritis	Deceased, female, 26 years old, intracranial hemorrhage	-	Donor: Isolated fever 10 days before brain death (eve of elective cesarean section). She was hospitalized 10 days later with intracranial hemorrhage and brain death. Receiver: Asymptomatic. Mild elevation of AST, with normal ALT.	Classic dengue without complications	Alive	Donor: D-10: PCR DENV-;D-10: NS1-; D0: PCR DENV- (blood); D0: PCR DENV+ (urine). Receiver: D0: IgG-/IgM-; D9-16: PCR DENV2+ (blood); D13: IgM+.
Jayant et al.²⁶26 Jayant D, Behera A, Kaman L, Savlania A, Tandup C, Naik K. Dengue transmission from donor to recipient after deceased donor liver transplant; report of a case and review of literature: is liver a privileged organ? Exp Clin Transplant 2022;20(10):959-64. https://doi.org/10.6002/ect.2022.0136 https://doi.org/10.6002/ect.2022.0136...	India	Liver/female, 19 years old, cirrhosis due to Wilson’s disease	Deceased, no other data	8	Donor: No data and no samples for testing. Receiver: D8: fever, chills, tachycardia and tachypnea. Mild elevation of transaminases; D16: hypotension, acute respiratory distress, shock, ascites.	Severe dengue with organ dysfunction	Alive	Donor: No samples. Receiver: D8: NS1+/IgM+/IgG-; the other two organ recipients (kidney) from the same donor: NS1+ e IgM+.

Associação Brasileira de Transplante de Órgãos Avenida Paulista, 2.001 - 17° andar Conj. 1.704/1.707, Cerqueira César - CEP: 01311-300, Tel: (55) 11 98243 - 3901 - São Paulo - SP - Brazil
E-mail: abto@abto.org.br

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[1] * Corresponding author: danielinfectologista@gmail.com