Infection After Lung Transplantation

  • I.L Paradis


Infection remains the most common cause of morbidity and mortality after lung transplantation (LTx)[1]’[3]. Of the 402 lung allograft procedures that were performed in 386 recipients at the University of Pittsburgh between 1982 and 1 July 1995, 187 allografts (47%) in 180 recipients (47%) failed (Table 1). Because some infections were due to more than one type of organism (e.g. bacteria plus Aspergillus), 115 infectious organisms were responsible for the failure of 97 (52%) allografts in 86 (48%) recipients that failed primarily due to infection. However, since 1989, infection has declined significantly from 46% to 32% as an etiology, from 80% to 53% as a cause of allograft failure, and from 85% to 54% as a cause of recipient death. This occurred because of the cumulative effect of a small decline in the prevalence of each type of infectious organism as a cause of allograft failure. Because infection has been the primary cause of failure in 53-54% of the grafts that have failed since 1989, it still remains the principal and unacceptable cause of allograft failure and death after LTx.


Acute Rejection Lung Transplantation None None Chronic Rejection Obliterative Bronchiolitis 
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  1. 1.
    Dauber HH, Paradis IL, Dummer JS. Infectious complications in pulmonary allograft recipients. In: Grossman R, Maurer J, editors. Pulmonary consideration in transplantation clinics in chest medicine. Philadelphia, PA: Saunders; 1980;22:291.Google Scholar
  2. 2.
    Maurer JR, Tullis E, Grossman RE et al. Infectious complications following isolated lung transplantation. Chest. 1992:101:1056.PubMedGoogle Scholar
  3. 3.
    Paradis IL, Williams P.Infections after lung transplantation. In: Sarosi GA, Trulock EP, editors. Infectious complications of transplantation. Seminars in respiratory infection. Philadelphia, PA: Saunders; 1993;8:207.Google Scholar
  4. 4.
    Dummer JS, Hardy A, Poorsattar A, Ho M. Early infections in kidney, heart and liver transplant recipients on cyclosporin. Transplantation. 1983;36:259.PubMedCrossRefGoogle Scholar
  5. 5.
    Dummer JS, Montero CG, Paradis IL et al. Infections in heart-lung transplant recipients. Transplantation. 1986;41:725.PubMedCrossRefGoogle Scholar
  6. 6.
    Hofflin JM, Potasman I, Baldwin JC et al. Infectious complications in heart transplant recipients receiving cyclosporin and corticosteroids. Ann Intern Med. 1987;106:209.PubMedGoogle Scholar
  7. 7.
    Brooks RG, Hofflin JM, Jamieson SW, Stinson EB, Remington JS. Infectious complications in heart-lung transplant recipients. Am J Med. 1985;79:412.PubMedCrossRefGoogle Scholar
  8. 8.
    Hosenpud JD, Hershberger RE, Pantely GA et al. Late infection in cardiac allograft recipients: profiles, incidence and outcome. J Heart Lung Transplant. 1991;10:380.PubMedGoogle Scholar
  9. 9.
    Mancini MC, Griffith BP, Tauxe WN. Assessment of ciliary function in the tracheobronchial tree of the heart-lung transplant recipient. Surg Forum. 1987;38:300.Google Scholar
  10. 10.
    Dolovich M, and the Toronto Lung Transplant Group. Muco-ciliary function in patients following single lung or lung-heart transplantation. Am Rev Respir Dis. 1987;135:A363.Google Scholar
  11. 11.
    Shankar S, Fulsham L, Read RC et al. Mucociliary function after lung transplantation. Transplant Proc. 1991;23:1222.PubMedGoogle Scholar
  12. 12.
    Read RC, Shankar S, Rutman A et al. Ciliary beat frequency and structure of recipient and donor epithelia following lung transplantation. Eue Respir J 1991;4:796.Google Scholar
  13. 13.
    Herve P and the Paris-Sud Lung Transplant Group. Impairment of bronchial mucociliary clearance in long-term survivors of heart-lung and double-lung transplantation. Chest. 1993;103:59.PubMedGoogle Scholar
  14. 14.
    Paradis IL, Marrari M, Zeevi A et al. HLA phenotype of lung lavage cells following heart-lung transplantation. J Heart Transplant. 1985;4:422.PubMedGoogle Scholar
  15. 15.
    Zenati M, Dowling RD, Dummer JS et al. Influence of donor lung on the development of early infections in heart-lung transplant recipients. J Heart Transplant. 1990;5:502.Google Scholar
  16. 16.
    Dowling RD, Zenati M, Yousem SA et al. Donor-transmitted pneumonia in experimental lung allografts. Successful prevention with donor antibiotic therapy. J Thorac Cardiovasc Surg. 1992;103:767.PubMedGoogle Scholar
  17. 17.
    Guilinger RA, Paradis IL, Dauber JH et al. The importance of bronchoscopy with Iransbronchial biopsy and bronchoalveolar lavage in the management of lung transplant recipients. Am J Respir Crit Care Med. 1995;152:2031.Google Scholar
  18. 18.
    Martinez JAB, Paradis IL, Dauber JH et al. Spirometry values in stable lung transplant recipients. Am J Respir Crit Care Med. (In press).Google Scholar
  19. 19.
    Thorpe JK, Baughman RP, Frame PT, Wesseler TA, Staneck JL. Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. J Infect Dis, 1987;155:855.PubMedGoogle Scholar
  20. 20.
    Kahn FW, Jones JM. Diagnosing bacterial infection by bronchoalveolar lavage. J Infect Dis. 1987;155:862.PubMedGoogle Scholar
  21. 21.
    Chastre J, Fagon JY, Soler P et al. Diagnosis of nosocomial pneumonia in intubated patients undergoing ventilation, comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med 1988;85:499.PubMedCrossRefGoogle Scholar
  22. 22.
    Johanson WG, Seidenfeld JJ, Gomez P, de los Santos R, Coalson JJ. Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. AmJ Respir Dis. 1988;137:259.Google Scholar
  23. 23.
    Torres A, de la Bellacssa JP, Xaubert A et al. Diagnostic value of quantitative cultures of bronchoalveolar favage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis. 1989;140:306.Google Scholar
  24. 24.
    Meduri GU, Chastre J. The standardization of bronchoscopic techniques for ventilation-associated pneumonia. Chest. 1992:102:557S.PubMedCrossRefGoogle Scholar
  25. 25.
    Chastre J, Fagon JY, Soler P, et al. Quantification of BAL cells containing intracellular bacteria rapidly idenlifies ventilated patients with nosocomial pneumonia. Chest. 1989;95:190S.Google Scholar
  26. 26.
    Neiderman MS, Torres A, Summer W. Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia. Am J Respir Crit Care Med. 1994;150:565.Google Scholar
  27. 27.
    Chastre J, Fagon JY. Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia. Am J Respir Crit Care Med. 1994;150:570.PubMedGoogle Scholar
  28. 28.
    Marquette CH, Copin MC, Wallet F et al. Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. Am J Respir Crit Care Med. 1995;151:1878.PubMedGoogle Scholar
  29. 29.
    Chastre J, Fagon JY, Bornet-Lecso M et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;152:231.PubMedGoogle Scholar
  30. 30.
    Stover DE, Zaman MB, Hajdu SI et al. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosappressed host. Ann Intern Med. 1984;101:1.PubMedGoogle Scholar
  31. 31.
    Broaddus C, Dake MD, Stulbarg MS et al. Bronchoalveolar lavage and transbronchial lung biopsy for the diagnosis ol pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med. 1985;102:747.PubMedGoogle Scholar
  32. 32.
    Pisani RJ, Wright AJ. Clinical utility of bronchoalveolar lavage in imnunocompromised hosts. Mayo Clin Proc. 1992;67:221.PubMedGoogle Scholar
  33. 33.
    Higenbottam T, Stewart S, Penketh A, Wallwork J. Transbronchial lung biopsy for the diagnosis of rejection in heart-lung transplant patients. Transplantation, 1988;46:532.PubMedCrossRefGoogle Scholar
  34. 34.
    Yousem SA, Paradis IL, Dauber JH, Griffith GP Efficacy of transbronchial lung biopsy in the diagnosis of bronchiolitis oblitierans in heart-lung transplant recipients. Transplantation. 1989;47:893.PubMedCrossRefGoogle Scholar
  35. 35.
    Yousem SA, Paradis IL, Griffith BP. Can transbronchial lung biopsy aid in the diagnosis of bronchiolitis obliterans in lung transplant recipients? Transplantation. 1994;57:151.PubMedCrossRefGoogle Scholar
  36. 36.
    Paradis IL, Duncan SR, Dauber JH et al. Distinguishing between injection, rejection and the adult respiratory distress syndrome after human lung transplantation. J Heart Lung Transplant. 1992;11:232S.Google Scholar
  37. 37.
    Paradis I, Yousem S, Griffith B. Airway obstruction and bronchiolitis obliterans after lung transplantation. In: King TE, editor. Clinics in chest medicine. Philadelphia, PA: Saunders; 1993;24:751.Google Scholar
  38. 38.
    Maurer JR. Lung transplantation bronchiolitis obliterans. In: Epler GR. editor. Diseases of the bronchioles. New York: Raven Press; 1994:275.Google Scholar
  39. 39.
    Snell GI, de Hoyas A, Krajden M, Winton T, Maurer JR. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest. 1993;103:466.PubMedGoogle Scholar
  40. 40.
    Lewiston N, King V, Umetsu D et al. Cystic fibrosis patients who have undergone heart-lung transplantation benefit from maxillary sinus antrostomy and repeat sinus lavage. Transplant Proc. 1991;23:1207.PubMedGoogle Scholar
  41. 41.
    McGowan JE. Anti-microbial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5:1033.PubMedGoogle Scholar
  42. 42.
    Sanders WH, Sanders CC. Inducible β-luctamases: clinical and epidemiologic implications for use of newer ecphalosporins. Rev Infect Dis. 1988;10:830.PubMedGoogle Scholar
  43. 43.
    Peterson LP, Quick JN, Jensen B et al. Emergence of eiprofloxacin resistance in nosocomial methicillin-resistant S. aureus colonization. Arch Intern Med. 1990:150:2151.PubMedCrossRefGoogle Scholar
  44. 44.
    Trucksis M, Hooper DC, Wolffson JS. Emerging resistance to fluoroquinolones in staphylococci: an alert.(Editorial) Ann Intern Med. 1991;114:424.PubMedGoogle Scholar
  45. 45.
    Chow JW, Fine MJ, Shales DM et al. Enterbacter hacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991:115:585.PubMedGoogle Scholar
  46. 46.
    Neu HC. The crisis in antibiotic resistance. Science. 1992;257:1064.PubMedCrossRefGoogle Scholar
  47. 47.
    Kunin CM. Resistance to anti-microbial drugs. A worldwide calamity. Ann Intern Med. 1993;118:557.PubMedGoogle Scholar
  48. 48.
    Meyer KS, Urban C, Eagan JA, Berger BJ, Rahal JJ, Nosocomial outbreak of Klebsitella infection resistant to late-generation ecphalosporins. Ann Intern Med. 1993;119:353.PubMedGoogle Scholar
  49. 49.
    Pear SM, Williamson TH, Bettin KM, Gerding ON, Galgiani JN. Decrease in nosocomial Clostridium difficite-associated diarrhea by restricting clindamycin use. Ann Intern Med. 1994;120:272.PubMedGoogle Scholar
  50. 50.
    Weller TH. The cytomegalovirus: ubiquitous agents with protean clinical findings. N Engl J Med. 1971;285:203, 267.PubMedCrossRefGoogle Scholar
  51. 51.
    Dummer JS, White LT, Ho M et al. Morbidity of cytomegalovirus infection in recipients of heart or heart-lung transplants who received cyclosporin. J Infect Dis. 1985;152:1182.PubMedGoogle Scholar
  52. 52.
    Burke CM, Glanville AR, Macoviak JA et al. The spectrum of cytomegalovirus infection following human heart-lunu transplantation. J Heart Transplant. 1986;5:267.PubMedGoogle Scholar
  53. 53.
    Duncan AJ, Dummer JS, Paradis IL et al. Cytomegalovirus infection and survival in pulmonary transplant recipients. J Heart Lung Transplant. 1991;10:638.PubMedGoogle Scholar
  54. 54.
    Maurer J, Tullis E, Scavuzzo M, Patterson GA. Cytomegalovirus infection in isolated lung transplant recipients. J Heart Lung Transplant. 1991;10:647.PubMedGoogle Scholar
  55. 55.
    Smyth RL, Scott JP, Borysiewicz LK et al.Cytomegalovirus infection in heart-lung transplant recipients: risk factors, clinical associations and response to treatment. J Infect Dis. 1991;164:1045.PubMedGoogle Scholar
  56. 56.
    Duncan SR, Paradis IL, Yousem SA et al. Sequelae of cytomegalovirus pulmonary infections in lung aIIograft recipients. Am Rev Respir Dis. 1992;146:1419.PubMedGoogle Scholar
  57. 57.
    Ettinger NA, Bailey TC, Trulock EP et al. Cytomegalovirus infection and pneumonitis. Impact after isolated lung transplantation. Am Rev Respir Dis. 1993;147:1017.PubMedGoogle Scholar
  58. 58.
    Zeevi A, Uknis MK, Spichty KJ et al. Proliferation of cytomegalovirus primed lymphocytes in bronchoalveolar lavage from lung transplant patients. Transplantation. 1992;54:635.PubMedCrossRefGoogle Scholar
  59. 59.
    Gleaves CA, Smith TF, Shuster EA, Pearson GR. Comparison of standard lube and shell vial cell culture techniques for the detection of cytomegalovirus in clinical specimens. J Clin Microbiol. 1985;21:217.PubMedGoogle Scholar
  60. 60.
    Paya CV, Wold AD, Smith TF. Detection of cytomegalovirus infections in specimens other than urine by the shell vial assay and conventional tube cell cultures. J Clin Microbiol. 1987;25:755.PubMedGoogle Scholar
  61. 61.
    Paradis IL, Grgurich WF, Dummer JS, Dekker A, Dauber JH, Rapid detection of cytomegalovirus pneumonia from lung lavage cells. Am Rev Respir Dis. 1988;138:697.PubMedGoogle Scholar
  62. 62.
    Crawford SW, Bowden RA, Hackman RC et al. Rapid detection of cytomegalovirus pulmonary infection by bronchoalveolar lavage and centrifugation culture. Ann Intern Med. 1988;108:180.PubMedGoogle Scholar
  63. 63.
    Emanuel D, Peppard J, Stover D et al. Rapid immunodiagnosis of cytomegalovirus pneumonia by bronchoalveolar lavage using human and murine monoclonal antibodies. Ann Intern Med. 1986;104:476.PubMedGoogle Scholar
  64. 64.
    van der Bij W, Schirm J, Torensma R et al. Comparison between viremia and antigenemia for detection of cytomegalovirus in blood. J Clin Microbiol. 1988;26:2531.PubMedGoogle Scholar
  65. 65.
    Gerna G, Revello MG, Percivalle E et al. Quantification of human cytomegalovirus vircmia by using monoclonal antibodies to different viral proteins. J Clin Microbiol. 1990:28:2681.PubMedGoogle Scholar
  66. 66.
    Ho M. Cytomegalovirus: biology and infection. New York: Plenum; 1991.Google Scholar
  67. 67.
    Erice A, Holm MA, Gill PC et al. Cytomegalovirus (CMV) antigenemia assay is more sensitive than shell vial cultures for rapid detection of CMV in polymor-phonuciear blood leukocytes. J Clin Microbiol. 1992;30:2822.PubMedGoogle Scholar
  68. 68.
    Cussol SA, Poon MC, Pal R et al. Primer-mediated enzymatic amplification of cytomegalovirus (CMV) DNA. Application to the early diagnosis of CMV infection in marrow transplant recipients. J Clin Invest. 1989;83:1109.Google Scholar
  69. 69.
    Jiwa NM, Gemert GW, Raap AK et al. Rapid detection of human cytomegalovirus DNA in peripheral blood leukocytes of viremic transplant recipients by the polymerase chain reaction. Transplantation. 1989;48:72.PubMedCrossRefGoogle Scholar
  70. 70.
    von Willebrand E, Pettersson K, Ahouen J, Hayry P. CMV infection. Class II antigen expression, and human kidney allograft rejection. Transplantation. 1986;42:364.CrossRefGoogle Scholar
  71. 71.
    Khoury E, Percira L, Greenspan FS. Induction of HLA-DR expression on thyroid follicular cells by cytomegalovirus infection in vitro. Am J Pathol. 1991;138:1209.PubMedGoogle Scholar
  72. 72.
    Bando K, Paradis IL, Konishi H et al. Obliterative bronchiolitis after lung and heart-lung transplantation: An analysis of risk factors and management. J Thorac Cardiovasc Surg. 1995;110:1.CrossRefGoogle Scholar
  73. 73.
    Geist LJ, Monick MM, Stinski MF, Hunninghake GW. Cytomegaluvirus immediate early cones prevent the inhibitory effect of cvclosporin A on interlcukin 2 gene expression. J Clin Invest. 1992;90:2136.PubMedCrossRefGoogle Scholar
  74. 74.
    Duncan SR, Paradis IL, Dauber JH et al. Ganeiclovir prophylaxis for cytomegalovirus infections in pulmonary allograft recipients. Am Rev Respir Dis. 1992;146:1213.PubMedGoogle Scholar
  75. 75.
    Duncan SR, Grgurich WF, lacono AT et al. A comparison of ganciclovir and acyclovir to prevent cytomegalovirus after lung transplantation. Am J Respir Crit Care Med. 1994;150:146.PubMedGoogle Scholar
  76. 76.
    Bailey TC, Trulock EP, Fttinger NA et al. Failure of prophylactic ganciclovir to prevent cytomegalovirus disease in recipients of lung transplants. J Infect Dis. 1991;165:548.Google Scholar
  77. 77.
    Maurer JR, Snell G, de Hoyos A, Kesten S, Winton T. Outcome of lung transplantation using three different cytomegalovirus prophylactic regimens. Transplant Proc. 1993;25:1434.PubMedGoogle Scholar
  78. 78.
    Gould FK, Freeman R, Taylor CE et al. Prophylaxis and management of cytomegalovirus pneumonitis after lung transplantation: review of experience in one center. J Heart Lung Transplant. 1993;12:695.PubMedGoogle Scholar
  79. 79.
    Kelly JL, Albert RK, Wood DM, Raghu G, Efficacy of a 6-week prophylactic ganciclovir regimen and the role of serial cytomegalovirus antibody testing in lung transplant recipients. Transplantation. 1995;59:1144.PubMedCrossRefGoogle Scholar
  80. 80.
    Drew WL, Ives D, Lalezari JP et al. Oral ganeiclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. N Engl J Med. 1995;333:615.PubMedCrossRefGoogle Scholar
  81. 81.
    Kramer MR. Denning DW. Marshall SE et al. Ulcerative tracheobronchitis after lung transplantation. A new form of invasive aspergillosis. Am Rev Respir Dis. 1991;144:552.PubMedGoogle Scholar
  82. 82.
    Yeldandi V, Laghi F, MeCabe MA et al. Aspergillus and lung transplantation. J Heart Lung Transplant. 1995;14:883.PubMedGoogle Scholar
  83. 83.
    Dowling RD, Baladi N, Zenati M et al. Disruption of the aortic anastomosis after heart-lung transplantation. Ann Thorac Surg. 1990;49;118PubMedCrossRefGoogle Scholar
  84. 84.
    Gryzan S, Paradis IL, Zeevi A et al. Unexpectedly high incidence of Pneumocystis carinii infection after heart-lung transplantation: implications for lung defense and allograft survival. Am Rev Respir Dis. 1988;137:1268.PubMedGoogle Scholar
  85. 85.
    Gray J, Wreghill TG, Pavel P et al. Epstein-Barr virus infection in heart and heart-lung transplant recipients: incidence and clinical impact. J Heart Lung Transplant. 1995;14:640.PubMedGoogle Scholar
  86. 86.
    Armitage JM, Kormos RL, Stuart S et al. Post-transplant lymphoproliferative disease in thoracic organ transplant patients: ten years of cyclosporin-based immunosuppression. J Heart Lung Transplant. 1991;10:877.PubMedGoogle Scholar
  87. 87.
    Randhawa PS, Yousem SA, Paradis IL et al. The clinical spectrum, pathology and clonal analysis of Epstein-Barr virus-associated lymphoproliferative disorders in heart-lung transplant recipients. Am J Clin Pathol. 1989;92:177.PubMedGoogle Scholar
  88. 88.
    Nunley D, Dauber J, lacono A et al. Ten year experience with post-transplant lymphoproliferative disease following lung transplantation. Am Rev Respir Crit Care Med 1994;149:A731.Google Scholar
  89. 89.
    Starzl TE, Porter KA, Iwatsuki S et al. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin steroid therapy. Lancet. 1984;1:583.PubMedCrossRefGoogle Scholar
  90. 90.
    Shapiro RS, Chauvenet A, McGuire W, Pearson A, MeGlava P. Treatment of B cell lymphoproliferative disorders with interferon-a and intravenous gamma globulin. N Engl J Med. 1988;318:1334.PubMedCrossRefGoogle Scholar
  91. 91.
    Smyth RL, Higenbottam TW, Scott JP et al. Herpes simplex virus infection in heart-lung transplant recipients. Transplantation. 1990;49:735.PubMedCrossRefGoogle Scholar
  92. 92.
    Wendt CH, Fox JMK, Hertz MI. Paramyxovirus infection in lung transplant recipients. J Heart Lung Transplant. 1995;14:479.PubMedGoogle Scholar
  93. 93.
    Wreghitt TG, Taylor CED, Bahatvala JE, Bryant J. Wallwork J. Concurrent cytomegalovirus and coxsackie B virus infections in a heart-lung transplant recipient. J Infect. 1986;13:51.PubMedCrossRefGoogle Scholar
  94. 94.
    Carlson SE, Bergin CJ. Reactivation of tuberculosis in a donor lung after transplantation. Am J Radiol. 1990;154:95.Google Scholar
  95. 95.
    Dromer C, Nashel S, Velly J, Marligne C, Courand L. Tuberculosis in transplanted lungs. J Heart Lung Transplant. 1993;12:924.PubMedGoogle Scholar
  96. 96.
    Miller RA, Lanza LA, Kline JN, Geist LI. Mycobacterium tuberculosis in lung transplant recipients. Am J Respir Crit Care Med. 1995;152:374.PubMedGoogle Scholar
  97. 97.
    Trulock EP, Bolman RM, Genton R. Pulmonary disease caused by Mycobacterium chelonac in a heart-lung transplant recipient with obliterative bronchiolitis. Am Rev Respir Dis. 1989;140:802.PubMedGoogle Scholar
  98. 98.
    Colquhoun IW, Gascoigne AD, Gould K, Corris PA, Dark JH. Native pulmonary sepsis after single lung transplantation. Chest. 1991;52:319.Google Scholar
  99. 99.
    Horvath J, Dummer S, Loyd J et al. Infection in the transplanted and native lung after single lung transplantation. Chest. 1993;104:681.PubMedGoogle Scholar
  100. 100.
    Ciulli F, Tamm M, Dennis C et al. Donor-transmitted bacterial infection in heart-lung transplantation. Transplant Proc. 1993;25:1155.PubMedGoogle Scholar
  101. 101.
    Gottesdiener KM. Transplanted infections: donor-to-host transmission with the allograft. Ann Intern Med. 1989;110:1001.PubMedGoogle Scholar
  102. 102.
    Pereira BJG, Milford EL, Kirkman RL et al. Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis C antibody and in the recipients of their organs. N Engl J Med. 1992;327:910.PubMedCrossRefGoogle Scholar
  103. 103.
    Simouds RJ, Holmberg SD, Hurwitz RL et al. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med. 1992;326:726.CrossRefGoogle Scholar

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© Kluwer Academic Publishers 1996

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  • I.L Paradis

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