Transplant Patient Got AIDS From New Kidney

On Thursday, CDC released its report on the case of a kidney transplant recipient who contracted HIV from a living donor in a New York City hospital in 2009.

Neither the donor nor the recipient knew he or she was HIV-infected until approximately one year after the transplant surgery. The recipient's multiple hospitalizations were initially thought to be organ rejection. Then the patient was treated for oral and esophageal candidiasis, and HIV testing indicated a positive result. The recipient's CD4 cell count was found to be under 100. Also about one year post-transplant, the donor sought repeat STD testing with his primary care provider and learned he was HIV-positive. The transplant team became aware of his diagnosis during a one-year follow-up visit.

The donor had reported a previous syphilis diagnosis and a history of male sex partners in his initial transplant evaluation. Testing 79 days before the procedure showed no evidence of HIV, hepatitis B or C infection. However, the investigation revealed he had had unprotected sex with one male partner of unknown HIV status during the one year before the transplant, including the time between his initial evaluation and surgery for organ harvesting.

To prevent and screen for HIV in prospective living organ donors, CDC is recommending the following:

• All living donor candidates should have their initial serologic HIV tests confirmed with a combination of an HIV serologic test and nucleic acid testing as close to organ donation as possible, but no longer than seven days prior.
• All living donors should be counseled on avoiding risky behaviors before transplant surgery.
• Living donors with a history of high-risk behaviors should be given individualized counseling and provided with specific strategies to avoid these behaviors.
• Transplant recipients should be advised of the risk for HIV and other pathogens -- consistent with current policy -- since no available testing can completely eliminate these risks.

Increasingly, kidney transplants involve live donors -- from 32 percent of transplant surgeries in 1988 to 46 percent last year. Roughly 88,000 people are currently on the kidney waiting list, according to the United Network for Organ Sharing.

The report, "HIV Transmitted from a Living Organ Donor -- New York City, 2009," was published in CDC's Morbidity and Mortality Weekly Report (2011;60(10):297-301). To view the report, visit www.cdc.gov/mmwr/PDF/wk/mm6010.pdf.

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