Table 3:

Donor-derived cases of WNV in solid organ transplant recipients

Year, Location	Donor risk factors and testing	Organ donated	Onset of symptoms post-transplant	Recipient serum testing	Recipient CSF testing	Treatment	Outcome
2011 US45,96	Increased WNV activity in donor region Serum IgM and IgG pos, serum NAT neg, LN PCR pos, spleen PCR pos	Kidney	Day 10	NAT pos	NAT pos, IgM neg	IVIG, IFN α2b	Remained in coma, developed status epilepticus, died on day 23
		Kidney	Day 17	NAT pos, IgM pos	NAT pos, IgM neg	IVIG, IFN α2b, FFP containing WNV IgG	Resolved, no neurologic deficits
		Bilateral lungs	Day 20	NAT pos	NAT pos, IgM pos	IVIG, IFN α2b	Complete flaccid paralysis, multiple seizures, died on day 38
		Liver	Day 18	NAT neg, IgM neg, IgG pos	NAT pos, IgM neg	Oral ribavirin, IVIG	Resolved, asymptomatic
2011 Italy97,98	Donor mosquito bite NAT neg, IgM pos, IgG pos	Kidney	Day 10	NAT pos, IgM pos, IgG pos	NAT pos, IgM pos, IgG pos	WNV IgG-pos FFP	Neuroinvasive disease, remained in coma
		Kidney	Day 10	NAT pos, IgM pos, IgG pos	NAT pos, IgM pos, IgG pos	None	Neuroinvasive disease
		Liver	Asymptomatic	NAT neg, IgM pos, IgG pos	None	None	Asymptomatic infection
		Single Lung	Asymptomatic	NAT pos, IgM pos, IgG pos	None	None	Asymptomatic infection
		Heart	Asymptomatic	NAT neg, IgM neg, IgG neg	None	None	Not infected
2010 California89	Donor mosquito bite Serum NAT pos, IgM neg, IgG pos	Kidney	Day 8	IgM pos, IgG pos	NAT neg, IgM pos	Supportive care	Neuroinvasive disease, died
		Kidney	Asymptomatic	NAT pos, IgM pos, IgG pos	Not obtained	None	Asymptomatic
		Liver	Asymptomatic	NAT neg, IgM neg, IgG pos	Not obtained	None	Asymptomatic
2009 Italy45,57	Donor mosquito bite Serum NAT pos	Liver	Asymptomatic	NAT pos, IgM pos	Not obtained	Prophylaxis with WNV IgG+ FFP, Omr-IgG-am	Asymptomatic
2009 (Unpublished CDC data)89	Donor mosquito bite NAT pos, IgM pos, IgG equivocal	Kidney	Not described	Not described	Not described	Not described	Neuroinvasive disease, resolved
		Kidney	Asymptomatic	Not described	Not described	Not described	Asymptomatic
		Liver	Asymptomatic	Not described	Not described	Not described	Asymptomatic
2009 California48	Possible donor mosquito bite Serum NAT pos, IgM neg	Liver	Day 15	NAT neg, IgM pos, IgG neg 3 weeks later: IgG pos	IgM pos	IVIG	Neuroinvasive disease, resolved
2008 Louisiana44,89	Donor blood transfusion Serum NAT neg, IgM neg, IgG neg; one blood donor for organ donor IgM pos	Heart	Day 8	IgM pos	IgM pos	Supportive care	Neuroinvasive disease, survived
2005 New York, Pennsylvania92	Probable donor mosquito bite Serum NAT neg, IgM pos, IgG pos	Liver	Day 13	IgM pos	NAT pos, IgM pos	Omr-IgG-am	Neuroinvasive disease, coma
		Lung	Day 17	Day 19: IgM neg Day 23: IgM pos, IgG pos	Day 24: NAT neg, IgM neg Day 27: IgM pos, IgG pos	Omr-IgG-am	Neuroinvasive disease, coma
		Kidney	Asymptomatic	NAT pos, IgM neg, IgG pos	Not obtained	Prophylactic Omr-IgG-am	Asymptomatic
		Kidney	Asymptomatic	IgM neg, IgG neg, NAT neg	Not obtained	Prophylactic Omr-IgG-am	Not infected
2002 Georgia, Florida33,99,100	Donor blood transfusion Serum NAT pos	Kidney	Day 13	Day 22: IgM equivocal,IgG equivocal Day 42: IgM pos	IgM pos	None	Neuroinvasive disease, survived
		Kidney	Day 17	IgM neg, IgG neg	IgM neg, IgG neg	None	Neuroinvasive disease, died
		Heart	Day 8	NAT pos, IgM pos	IgM pos	None	Neuroinvasive disease, improved
		Liver	Day 7	IgM pos	Not obtained	None	Resolved

Abbreviations: d, days; FFP, fresh frozen plasma; IFN, interferon; IVIG, Intravenous immunoglobulin; LN, lymph node; mpNAT, minipool nucleic acid-amplification test; Neg, negative; PCR, polymerase chain reaction; Pos, positive; QOD, every other day; US, United States