Zika and Solid Organ Transplantation: Expert Guidance
Amesh A. Adalja, MD, FACP, FACEP, FIDSA, May 27, 2016
When an emerging infectious disease makes the leap from being “only” an outbreak to becoming an endemic disease that will be a continual threat, it changes the context of how we cope with the infection. This context includes how medicine and the healthcare industry will integrate knowledge about the infection into existing protocols, policies, and procedures. One area of modern medicine that is uniquely attuned to the risk of infections and mitigating their effects is transplant surgery. Because of the net state of immunosuppression required to prevent rejection of a foreign organ, transplant patients are exquisitely susceptible to a variety of infections—some of which are donor-derived. While infections such as cytomegalovirus, for example, are well characterized, emerging infectious diseases such as West Nile can also complicate transplantation. With the ongoing spread of Zika in the Americas, it, like many other emerging infectious diseases, has become a factor to be considered in solid organ transplantation.
A new paper, whose lead author, Dr. Fernanda Silveira, is my colleague at the University of Pittsburgh, was just published in the Journal of Heart and Lung Transplantation. It outlines a potential approach to delimiting the risk of Zika infections in solid organ transplant patients.
A Cautious Approach
Because of the lack of data regarding Zika virus in transplant patients, the lack of a robust donor screening antibody test, and the high rate of asymptomatic infections, Silveira and co-author Sylvia Campos argue for a cautious approach. Their expert recommendations for both potential recipients and for donors include:
- Advising the avoidance of travel, if possible, for organ transplant recipients and patients on waiting lists for transplantation;
- Advising safe sex practices for those engaging in sexual contact with a man with exposure to an area with Zika transmission;
- Enhancing donor screening with inquiries regarding symptoms of Zika, travel to a Zika-affected area, or sex with a potentially Zika-exposed man;
- A deferral of acceptance of organs from a Zika-infected donor for a period of 6 months after symptom resolution;
- Asymptomatic donors with potential exposure to Zika can be considered on an individual basis after reviewing the risks and benefits involved;
- Living donors with potential exposure to Zika should defer donation for 4 weeks after exposure; and
- Living donors with confirmed Zika should defer donation for 6 months (or in a dire situation should donate only if PCR is negative 4 weeks post-symptoms).
Though the current state of the Zika outbreak precludes major evidence-based guidance, Silveira and Campos have provided an important guidepost for organ transplantation centers worldwide. The absence of data makes crafting recommendations daunting, but it does not remove the need for expert guidance on the complicated calculus regarding donor selection and screening. As the Zika virus outbreak continues, organ transplant centers nationwide would do well to familiarize themselves with the important recommendations in this paper.
Silveira FP, Campos SV. The Zika epidemics and transplantation. J Heart Lung Transplant 2016;35:560-563.