Assessment of risk for transplant‐transmissible infectious encephalitis among deceased organ donors

• Published in: Transplant infectious disease 2018-10, Vol.20 (5), p.e12933-n/a
• Main Authors: Smalley, Hannah K., Anand, Nishi, Buczek, Dylan, Buczek, Nicholas, Lin, Timothy, Rajore, Tanay, Wacker, Muriel, Basavaraju, Sridhar V., Gurbaxani, Brian M., Hammett, Teresa, Keskinocak, Pinar, Sokol, Joel, Kuehnert, Matthew J.
• Format: Article
• Language: English
• Subjects: Abnormalities; Adult; Balamuthia mandrillaris; calculator; Cases (containers); Cerebrospinal fluid; Clinical Decision-Making - methods; Decision Support Techniques; decision‐support tool; Demographics; Demography; Diagnostic systems; Disease Transmission, Infectious - prevention & control; Disease Transmission, Infectious - statistics & numerical data; Donor Selection - standards; Encephalitis; Female; Fever; Health risks; HIV; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Infectious Encephalitis - epidemiology; Infectious Encephalitis - etiology; Infectious Encephalitis - prevention & control; lymphocytic choriomeningitis virus; Male; Mathematical analysis; Middle Aged; Models, Biological; Organ donors; Organ Transplantation - adverse effects; Organ Transplantation - methods; Organs; Predictions; rabies; Risk assessment; Risk Assessment - methods; Statistical analysis; Tissue Donors - statistics & numerical data; transplant; Transplantation; Transplants & implants; West Nile virus; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12933

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.