Clinical assessment of the utility of metagenomic next-generation sequencing in organs for transplantation from a donor with primary meningoencephalitis due to Naegleria fowleri
Wei Zhou1, Kang Huang1, Qiuyan Zhang2, Dongchi Zhao3, Junwen Zheng3, Wen Xie4, Yongwei Duan4, Xiaoyan Hu1, Guangjian Zhang5, Jie Cai6, Shaojun Ye1, Qifa Ye1.
1Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China; 2Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China; 3Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China; 4Department of Laboratory medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China; 5Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People's Republic of China; 6Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
OPO-MDT Group.
Although the number of deceased organ donation increases by years, organs for transplant are still facing a serious shortage worldwide. Some transplant centers have expanded the donor selection criteria by including donors with ongoing organ infection such as Naegleria fowleri infection. Naegleria fowleri infection was initially thought to be limited to the central nervous system and causing amoebic encephalitis. However, cases with extracranial infection of Naegleria fowleri were reported. Organs from these donors would potentially lead to the transmission of infection in immunosuppressed recipients and need to be precluded from the donor list. In the present study, we report a case of a 14-year-old male brain-dead donor dying of Naegleria fowleri infection and the extra-CNS dissemination of Naegleria fowleri was precluded by mNGS. After a thorough evaluation, liver, kidneys, heart, and left lung from this donor were used for transplant in five recipients. There was no evidence of transmission of infection within one and a half years of follow-up. The success of this case suggests that with a thorough medical evaluation, including using mNGS to preclude the potential spread of infection agents out of restricted sites, organs from those donors with limited infections were safe for transplantation.
[1] Naegleria fowleri
[2] organ donation
[3] metagenomic next-generation sequencing