Pre-transplantation testing: who, when and why?

An ever-widening range of human organs and tissues is being transplanted, l imited currently only by the ingenuity of surgeons and immunologists to ove rcome the physical and immune barriers, Microbiologists are in danger of be ing left behind. Although the major infective risks of human organ transpla ntation are now well understood, many details remain controversial, and the special risks associated with tissue banking have received little attentio n until recently. What should we do? Are we making mountains out of molehil ls? Are there any data on which to base a rational decision? Topics covered include: bacteriology of cadaveric heart valve transplantation (why are va lves not cultured and only dunked in antibiotic solution for 24 h, whereas endocarditis gets treated for 3 weeks?); screening for tissue-born viruses (why does everyone persist with serology when genomic methods are so much b etter?), screening organ donors for CMV (surely we should use the optimally ; sensitive combination of methods?); peripheral blood stem cell transplant s (should we culture these, and what do the positive results mean if we do? ); donor sputum screening before heart-lung transplantation (does this aid the post-operative management of the recipient?). With active participation from the floor some areas of consensus were identified and topics worthy o f scientific investigation in the future were highlighted. (C) 1999 Hospita l Infection Society.