Hepatitis B Virus NAT Positive Donors in Non-Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor-Derived Infection.

Transplantation is one of the few life-saving therapies for patients with end-stage organ disease, yet organ availability remains restrictive. Expanding donors to include those with hepatitis B virus (HBV) infection, incorporating HBV nucleic acid amplification testing (NAT) positive donors, could improve organ access. However, the risk of donor-derived HBV transmission and recipient management of organs transplanted from HBV NAT-positive donors, particularly in thoracic organ recipients, is limited.

Evaluating the introduction of COVID-19 oral antivirals through a test and treat program: outcomes from a cohort study in four African countries.

Introduction: Access to oral antivirals like nirmatrelvir/ritonavir to treat COVID-19 remains largely unavailable across Africa. Ghana, Malawi, Rwanda and Zambia, all members of the COVID Treatment QuickStart Consortium, leveraged existing infrastructure to rapidly commence COVID-19 test-and-treat programs. We describe the individual-level impact within the cascade of care.

HOPE in every breath and heartbeat: Understanding transplant eligibility, access barriers, and clinical outcomes in thoracic transplantation in persons with HIV.

Background: Persons with human immunodeficiency virus (PWH) are living longer, leading to increased end-organ disease from chronic illness. Organ transplantation improves survival in patients with end-organ disease yet remains a constrained resource due to limited access. We aimed to better understand barriers to transplantation for thoracic end-organ disease in PWH.

Long-term outcomes of a case-control lung transplant cohort after SARS-CoV-2 infection.

Background: Respiratory viruses can impact the allograft function in lung transplant recipients, but it is unknown if this occurs with SARS-CoV-2 infection. We studied the long-term outcomes of lung transplant recipients infected with SARS-CoV-2.

Methods: This single-center retrospective study compared lung transplant recipients with SARS-CoV-2 between June 2020 and April 2021 with a matched control group.

Safety and Efficacy of Pemivibart, a Long-Acting Monoclonal Antibody, for Prevention of Symptomatic COVID-19: Interim Results From a Phase 3 Randomized Clinical Trial (CANOPY).

Background: We report an interim analysis of safety and efficacy of pemivibart in individuals with (cohort A) or without (cohort B) significant immunocompromise in the phase 3 CANOPY trial.

Methods: Eligible participants (≥18 years; negative for current SARS-CoV-2 infection) received 2 intravenous 4500-mg pemivibart infusions (cohort A) or were randomized 2:1 to receive blinded pemivibart or placebo (cohort B) 90 days apart. Safety was a primary endpoint for both cohorts.

Beyond the HIV Organ Policy Equity Act: Roadmap to expanding kidney and liver transplants for people with human immunodeficiency virus utilizing grafts from donors with human immunodeficiency virus.

People living with human immunodeficiency virus (HIV) (PWH) face limited access to organ transplantation despite higher rates of end-organ disease. The HIV Organ Policy Equity Act, enacted in 2015, allowed transplants from donors with HIV to recipients with HIV (HIV D+/R+) under research protocols. Studies have since demonstrated overall comparable outcomes between HIV D+/R+ and donors without HIV/R+ transplants, leading to the removal of the research requirement for HIV D+/R+ kidney and liver transplants in November 2024.

Outcomes of lung transplantation from SARS-CoV-2 positive donors during the Omicron wave.

Early observations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission via lung transplantation have led to frequent discard of lungs from donors with positive SARS-CoV-2 tests. We compared survival between lung transplant recipients (LUTRs) with SARS-CoV-2 (+) ( = 11) and SARS-CoV-2 (-) donors ( = 192) transplanted from January 30, 2022 to March 31, 2024. Three of the 11 SARS-CoV-2 (+) donors had positive lower respiratory tract (LRT) tests.

The tell-tale hearts: Donor-derived invasive fungal infections among orthotopic heart transplant recipients.

Donor-derived invasive fungal infections among solid organ transplant recipients are rare but sometimes devastating events associated with notable morbidity and mortality. Here we describe two donor-derived fungal infections - one complex infection and one infection - that occurred among heart transplant recipients at a quaternary care center. Both recipients survived their infections, though with substantial morbidity despite aggressive surgical intervention and antifungal therapy.

Estimated Median Waiting Time for Organ Procurement and Transplantation Network Human Immunodeficiency Virus Organ Policy Equity Act Variance Kidney Candidates: A Propensity Score Matched Analysis.

Background: Prior to the 2013 HIV Organ Policy Equity (HOPE) Act, which enabled research on the transplantation of solid organs from donors with human immunodeficiency virus (HIV) to candidates living with HIV, it was prohibited for HIV+ individuals to donate organs in the United States. In 2015, alongside the release of HOPE Act research criteria, the Organ Procurement and Transplantation Network (OPTN) made organ allocation policy and system changes to allow HIV+ to HIV+ transplantation.

Methods: The OPTN database was queried for all adult kidney registrations ever waiting from November 23, 2015, to December 31, 2022; the cohort was split into a HOPE cohort (ever willing to accept an HIV+ kidney) and a non-HOPE cohort (all remaining).

Longitudinal analysis of viral dynamics in HIV+-to-HIV+ HOPE Act kidney-transplant recipients.

BACKGROUNDThe HIV Organ Policy Equity (HOPE) Act allows individuals living with HIV to accept organs from donors with HIV. This practice widens the pool of available organs, but also presents important virological issues, including the potential for HIV superinfection of the recipient, viral persistence in the kidney, and loss of virological control.METHODSWe addressed these issues by performing in-depth longitudinal viral sequence analyses on urine, blood, and urine-derived renal epithelial cells from 12 recipients of HIV+ kidney allografts.

Donor-derived infections in the United States: Opportunities to learn from the Disease Transmission Advisory Committee's experience.

The Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network focuses on issues related to the transmission of disease through organ transplantation. Providing a review of potential cases of transmission, translating aggregate data into actionable education and guidance for the transplant community, and providing input for policy development, DTAC aims to improve the safety of organ transplantation through a reduction in donor-derived transmission events. Through its nearly 20-year history, DTAC has provided education, guidance, and policy, addressed numerous emerging infections, and continuously focused on the community's understanding of risk assessment related to donor-derived transmission.

Challenging boundaries: Organ transplants from donors with Listeria central nervous system infections.

Pretransplant mortality rates in the US remain high and are connected to effective organ donation and utilization. Thus, there is a need to maximize the utilization of available donors. In some cases, this has been safely achieved using organs from donors with infectious complications.

Management of infectious disease syndromes in thoracic organ transplants and mechanical circulatory device recipients: a Delphi panel.

Purpose: Antimicrobial misuse contributes to antimicrobial resistance in thoracic transplant (TTx) and mechanical circulatory support (MCS) recipients. This study uses a modified Delphi method to define the expected appropriate antimicrobial prescribing for the common clinical scenarios encountered in TTx and MCS recipients.

Methods: An online questionnaire on managing 10 common infectious disease syndromes was submitted to a multidisciplinary Delphi panel of 25 experts from various disciplines.

"They paged me what?": A transplant infectious disease guide to donor calls.

Donor-derived infections in solid organ transplantation can be prevented by risk stratification of donors based on available information, and inquiries surrounding possible or diagnosed infection are common questions posed to transplant infectious disease subspecialists. This article outlines the five key steps in addressing a donor call from a transplant team in a systematic approach, focusing on donor and recipient-specific factors, transmissibility and treatment of possible infections, and the likelihood of a patient's future organ offers and mortality remaining on the waitlist. These principles are then applied to five donor call cases, in which we review the key takeaway points and supporting literature.

Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.

Background: Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals.

Methods: This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients.

Disparities in Mpox Vaccination Among Priority Populations During the 2022 Outbreak.

Background: The 2022 mpox outbreak disproportionately affected men who have sex with men and persons living with HIV (PLWH). A 2-dose mpox vaccine series was deployed in mid-2022. Structural racism and insurance status may have affected equitable vaccination.

Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation.

Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective study of 1156 consecutive lung transplants performed from 2010-2019. We used log-binomial regression to identify risk factors for infection and analyzed clinical management and outcomes.

Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.

Background: Living kidney donation is possible for people living with HIV (PLWH) in the United States within research studies under the HIV Organ Policy Equity (HOPE) Act. There are concerns that donor nephrectomy may have an increased risk of end-stage renal disease (ESRD) in PLWH due to HIV-associated kidney disease and antiretroviral therapy (ART) nephrotoxicity. Here we report the first 3 cases of living kidney donors with HIV under the HOPE Act in the United States.

Concurrent Sexually Transmitted Infection Testing Among Patients Tested for Mpox at a Tertiary Healthcare System.

Coinfection with sexually transmitted infections (STIs) and mpox is common. We evaluated concurrent STI testing among Duke Health patients tested for mpox. We found that most patients tested for mpox were not comprehensively tested for STIs, despite concurrent STIs being diagnosed in 15% of patients when testing was performed.