Transmission of viral disease to the recipient through the donor liver

Morbidity and mortality after liver transplantation continue to be significantly influenced by infectious complications. A particular concern is transmission of pathogens through the graft, which may cause significant disease in the recipient.

For frequently transmitted herpes viruses with high seroprevalence such as cytomegalovirus, Epstein-Barr virus and human herpes viruses 6 and 7, significance, diagnosis, spectrum of disease in the recipient, prophylaxis and therapy are well established. Less is known about rare viruses such as West Nile virus, rabies virus, human choriomeningitis virus, human herpes virus 8 and human T-cell lymphoma 1, which are in many cases fatal. A plenitude of other viruses that potentially can be transmitted with a donor liver may exist, for which no detailed information is currently available. Grafts from anti-hepatitis B virus core antibody positive donors can be safely used when using lamivudine/hepatitis B immunoglobulin prophylaxis; hepatitis C virus positive organs should be given to hepatitis C virus positive individuals only.

With the utilization of increasingly extended criteria donors, the risk for transmission of viruses with the graft may become a more common complication. These viruses will include rare and new pathogens and testing donors for these viruses may become necessary.