Background: Donor acquired allergy (DAA) occurs when donors transfer their allergies to recipients through solid organ transplant (SOT). However, the risk of DAA in recipients of organs from allergic donors has not been systematically characterized.
Objective: We sought to synthesize the available evidence on the risk of DAA in SOT recipients.
Methods: We searched Embase and MEDLINE databases for original and peer-reviewed articles related to transplant allergy since database inception to February 11, 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias.
Results: The review included 24 studies with 747 SOT recipients and their 135 allergic donors in the category of food, drug, or venom. Only 40 recipients (5.4%) underwent allergy testing to donor allergens and 23 of them had the testing done before an exposure to donor allergens. Among the 30 recipients (4.0%) who were diagnosed with DAA based on a clinical reaction or positive allergy testing, 19 (2.5%) had anaphylaxis to donor allergens. Only the type of SOT (lung or liver) was associated with an increased risk of DAA (OR 88.0, 95% CI 22.5 to 481.3), with no association seen for other organs.
Conclusion: Despite the uncommon occurrence, recipients of organs from allergic donors could be at risk of severe allergic reactions to donor allergens. Although infrequently performed, allergy testing to donor allergens can effectively assess the risk of developing DAA. These findings highlight the risk of DAA and underscore the importance of proactive allergy assessment to prevent unnecessary anaphylaxis in this vulnerable population.
Keywords: donor allergy labels; drug allergy; food allergy; solid organ transplant; transplant acquired allergy; venom allergy.
Copyright © 2025. Published by Elsevier Inc.