Changes in Sero-immunological Status for Infectious Diseases in Solid Organ Transplantation: A 20-Year Single-Center...

With increasing solid organ transplantations (SOTs), updated sero-immunological data are essential, as immune profiles shift across generations and influence preventive strategies. We aimed to evaluate the current sero-immunological status of SOT recipients in Korea.

We retrospectively analyzed pre-transplant sero-immunological test results for 12 infectious diseases from SOT recipients and donors at a single center over 20 yrs. All serological test results obtained during pre-transplant evaluations were included; identical results from repeat tests conducted within 1 yr were excluded. Temporal trends in seropositivity were assessed based on test year, age at testing, and birth cohort.

In total, 51,096 pre-transplant serological test results (35,159 from recipients and 15,937 from donors) were analyzed. Seropositivity rates remained stable throughout the test year, except for a decline for tuberculosis-specific interferon-gamma release assay (TB IGRA). By birth cohort, seropositivity for varicella-zoster virus (98.8%), herpes simplex virus (HSV; 95.7%), and cytomegalovirus (CMV, 99.4%) was high in individuals born before the 1980s but declined in younger cohorts (69.3%, 46.6%, and 81.1%, respectively; all P < 0.001). The overall proportions of donor-positive/recipient-negative transplantation remained stable (CMV 1.3%, HSV 3.8%, and Epstein-Barr virus 2.5%). Seropositivity for hepatitis A virus and measles decreased markedly in individuals born after the 1980s (35.7% and 77.9%, respectively) compared with those born earlier (84.3% and 94.1%; both P < 0.001). Toxoplasma antibody and TB IGRA positivity (both P <0.001) demonstrated significant age-dependent declines across SOT recipients.

The sero-immunological landscape of SOT candidates has changed over time, reflecting generational shifts in Korean society. These changes highlight the importance of targeted screening and tailored management, particularly for high-risk donor-seropositive/recipient-seronegative transplantations, as well as the critical need for timely immunization in transplant candidates.