It's unknown how often transplant-related infections occur, but they could be treated if more information is shared between doctors and hospitals.

02:04 AM EDT on Friday, May 27, 2005

BY FELICE J. FREYER
Journal Medical Writer

The recent deaths of three transplant recipients who caught a virus from the donated organs have intensified calls for a system to keep doctors better informed of such events -- and raised the question of whether transplant-related infections may be occurring more often than recognized.

Four patients received organs last month from a Rhode Island donor who unknowingly carried a rodent-borne virus. All became ill, and only one survived. But the source of the recipients' illness might never have come to light if two of them hadn't been at the same hospital, where their doctor noticed the similarities and set an investigation in motion.

"There's no doubt there needs to be better communication, a way to track what happens to people," said Dr. Staci A. Fischer, an infectious-disease specialist at Rhode Island Hospital, where the two kidney transplants were done.

Dr. Matthew J. Kuehnert, assistant director for blood safety at the Centers for Disease Control and Prevention, said it's unknown how often transplant-related infections occur, although he believes they are rare.

Journal photo / Ruben W. Perez

"There's no doubt," says Dr. Staci A. Fischer, an infectious-disease specialist at Rhode Island Hospital, "there needs to be . . . a way to track what happens to people."

"This is not just about a rodent virus," he said. "It's about all sorts of unknown illnesses that we probably don't recognize, and we probably can if we enhance our efforts."

Infections that don't hurt a healthy person can be deadly to transplant recipients because their immune systems are suppressed to prevent rejection of the new organ.

Fischer said it had been a struggle to diagnose her surviving patient. She found no help in the medical literature and didn't learn about a similar incident in Wisconsin until after CDC investigators identified the virus. She said she also met with obstacles getting information about the donor from the New England Organ Bank. The organ bank says it was fully cooperative.

"There's not a formalized mechanism where unusual infections are reported to organ procurement organizations," said Dr. Jay A. Fishman, director of transplant infectious diseases at Massachusetts General Hospital, where the liver from the Rhode Island donor was transplanted. "It's not that we don't know that this is a problem."

Even before the recent incident, the CDC had scheduled a meeting next month to address the issue, Fishman said.

Last year, three people died after being transplanted at a Texas hospital with organs infected with rabies. In Wisconsin in 2003, four transplant recipients who received their organs from the same donor died; three of the recipients, but not the donor, tested positive for the same rodent-borne virus that caused the New England deaths. And in 2002, donated organs in Georgia infected four people with West Nile virus; one died.

"All the cases that we've seen so far have been because there are multiple recipients in the same hospital that transplanted at the same time," said Kuehnert, of the CDC. "In places where there's one patient in one place and one patient in another, we may not know about it."

Kuehnert said that CDC is talking with transplant doctors on ways to better recognize unusual infections and improve communication among the people involved, and also to improve diagnostic testing.

Prospective donors are tested for syphilis and five viruses, including HIV, and questions are asked about the donor's health. There is no commercially available test for the rodent virus, lymphocytic choriomeningitis virus or LCMV, which is very hard to detect and usually causes no symptoms in healthy people. Tests for other germs are sometimes too slow to be useful; organs are viable for only a limited time.

Even so, Fishman, of Mass. General, said he believes that infections from transplanted organs remain rare "because the system works pretty well to screen out infection. We do know a fair amount about the donor by the time those organs are made available for transplantation."

The Rhode Island donor, who died of a stroke, had shown no signs of infection. The people who received her lungs, liver and kidneys on April 10 and 11 initially did well. The kidney recipients even went home to recuperate.

One of the kidney patients returned to Rhode Island Hospital on April 27, suffering from fever, diarrhea and liver troubles. Fischer was puzzled by his symptoms, which typically don't occur together. Then, on May 2, the other kidney patient came to the hospital with the same symptoms. Fischer noticed the two had received their transplants on the same day, and knew something strange was going on.

Fischer called the New England Organ Bank, which quickly put her in touch with the Boston doctors for the recipients of the donor's other organs. She learned that one Boston patient had already died, and the other was dying -- all with the same symptoms as the kidney patients. On May 3, the doctors contacted the CDC. The next day, one of the kidney recipients died.

As the CDC investigation started, Fisher tried to learn more on her own. She said the New England Organ Bank declined to get her information about the donor, such as whether the person had pets or hobbies, or had traveled. "They didn't want to alert the donor family that something was wrong," she said. "I kept saying, 'There's one guy still alive. I need to save his life.'"

Fischer also contacted the Rhode Island Health Department to let them know what was going on, and health officials decided to contact the donor's family.

Sean Fitzpatrick, spokesman for the New England Organ Bank, disputed Fischer's account, saying that the organ bank "supports re-contacting donor families when complications in transplants arise if it is clear that such information would be clinically helpful. This case was no different. The issue was moot because the [department of health] contacted the family."

Fishman, the Mass. General doctor, also had no complaints: "As soon as the organ bank figured out what was going on they were very responsive," he said.

In any case, the Health Department learned that the donor owned a hamster. Soon after, on May 7, Fischer heard from the CDC that testing had identified the class of viruses involved, and hours later it pinpointed LCMV.

Finally, Fischer knew what to do. A report issued yesterday by the CDC describes what happened: She reduced the patient's antirejection medication and gave him an antiviral drug. And, the CDC said, he started to get better.