Donor-derived latent viral and parasitic infections in solid organ transplant recipients: old foes and emerging challenges

PURPOSE OF REVIEW: Anticipated donor-derived infections following solid organ transplantation are a unique type of iatrogenic infection where a transplant recipient is knowingly infected with a potential pathogen, where the overall benefit of transplantation is felt to outweigh the risk of infection or infection-related complication. This review summarizes recent updates in our understanding of the safety and ongoing challenges of common donor-positive-to-recipient-negative transplantation. RECENT FINDINGS: Registry analyses, case series, and cohort studies comprise the most recent publications on donor-derived infections. Changing patient populations, treatments, diagnostics, and awareness of rare disease presentations are associated with changes in the reported incidence, prevalence, and severity of donor-derived infections. SUMMARY: Donor-positive to recipient-negative transplantation continues to be an overwhelmingly safe approach to optimize donor utilization rates, improve transplant-related outcomes, and minimize waitlist mortality. Changes to donor/recipient demographics, immunosuppressive and antiinfective regimens, as well as evolving pathogen endemicity, are associated with changes in the prevalence and severity of donor-derived infectious outcomes.