No Pretransplant Infectious Disease Testing Needed for Recipients Under Age 12

Pediatric solid organ transplants recipients under the age of 12 will no longer require pretransplant testing for HIV and hepatitis B and C (HBV and HCV) as long as they had been tested postnatally, according to updated US Public Health Service recommendations.

The previous 2020 guideline was updated based on “the potential for harm that infectious disease testing might pose to some pediatric recipients because of blood volume loss from testing, including risks related to preoperative low body weight and blood volume, anemia, and exacerbation of underlying comorbid conditions,” noted the new guideline’s lead author Rebecca J. Free, MD, from the Centers for Disease Control’s National Center for Emerging and Zoonotic Infectious Disease.

Testing had been previously required for transplant recipients during hospital admission for transplant surgery “to more accurately assess their pretransplant infection status and to better identify donor transmitted infection,” noted Free and co-authors.

However, based on a review of available data, public comment, discussions with stakeholders from the transplant community, and input from a federal advisory committee, they concluded that children under age 13 “are among those at lowest risk for new HIV infections”, and that incidence of acute HBV and HCV infection in US residents under age 20 “is extremely low”.

They noted that posttransplant testing recommendations remain unchanged: “Testing for HIV, HBV, and HCV infections should be conducted for all transplant recipients at 4–6 weeks after transplantation, including those aged <12 years regardless of postnatal infectious disease testing.”

Asked to comment, Sandy Feng, MD, PhD, a transplant surgeon at the University of California San Francisco and editor-in-chief of the American Journal of Transplantation, told Medscape this is “a very reasonable” change in policy.

“First, the new recommendation is based on strong epidemiological data that the incidence of these infections is extremely low for those who have undergone postnatal testing,” she said in an email.

“Second, testing at the time of the transplant admission does not offer a specific, time-sensitive benefit as there remains the requirement for posttransplant testing. A positive test result after transplant would have strong therapeutic implications for the transplant recipient. Whether the positive result reflects infection present at the time of transplantation or infection that resulted during or after transplantation (through either the organ donor or blood product donors) is of secondary importance and can typically be thoroughly investigated and accurately delineated.”

The co-authors and Feng reported no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online July 1, 2022. Full text

Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.

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