Risk and benefits of expanded donor screening: A viewpoint from Germany.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-11-01 Epub Date: 2024-10-05 DOI:10.1111/tid.14384

Carl-Ludwig Fischer-Fröhlich, Paolo Grossi, Axel Rahmel, Ana-Paula Barreiros

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引用次数: 0

Abstract

This review describes the risks and benefits of expanding screening for transmissible pathogens in deceased organ donors. The focus is on the experience and procedure in Germany to make a decision on how to proceed with a possible donor. Three issues are of interest in how screening policies impact the process with the aim of mitigating unexpected transmission risks: (1) Should we add universal or targeted nucleic acid testing to serological tests for common blood-borne viruses (BBVs; HIV, HBV, and HCV)? (2) Which tests should be added for screening in a geographically restricted region beyond testing for these BBVs? (3) Being faced with changes (e.g., climate and population) in the own geographically restricted region, what strategies are needed before implementing new tests, and which considerations apply for proper indication to do this? Testing may only be effective when during donor characterization the appropriate conclusions are drawn from the existing findings and screening tests are initiated. This statement overlaps the need to implement universal screening for a pathogen or targeted screening based on the risk that the donor has acquired the transmissible pathogen or is not as possible to identify by current methods of clinical judgment and/or specific tests.

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扩大捐献者筛查范围的风险和益处：来自德国的观点。

本综述介绍了扩大对已故器官捐献者进行传染性病原体筛查的风险和益处。重点是德国在决定如何处理可能的捐献者方面的经验和程序。有三个问题值得关注，即筛查政策如何影响流程以降低意外传播风险：(1) 在常见血液传播病毒（BBVs；HIV、HBV 和 HCV）血清学检测的基础上，我们是否应该增加通用的或有针对性的核酸检测？(2) 在检测这些 BBVs 之外，还应在受地理限制的地区增加哪些检测项目以进行筛查？(3) 面对自身地理限制地区的变化（如气候和人口），在实施新检测前需要采取哪些策略？只有在供体特征描述过程中，从现有发现中得出适当结论并启动筛查测试，测试才可能有效。这一说法与实施病原体普遍筛查或根据捐献者已感染可传播病原体的风险或无法通过现有临床判断和/或特定检测方法识别的风险进行有针对性筛查的必要性相重叠。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.