A review of allograft processing and sterilization techniques and their role in transmission of the human immunodeficiency virus

Abstract

Human immunodeficiency virus (HIV) infection via vascular organ and tissue transplantation is well documented. The majority of these transmissions occurred before the development of HIV antibody testing, which is now a routine screening tool used before organ and tissue procurement and transplantation. There exists what is commonly referred to as a "window" of seronegativity after HIV infection. Potential donors may be infectious with the HIV virus but not yet detected with available HIV antibody tests. Bone and soft tissue retrieval may be done in either a sterile or clean, nonsterile manner. Deep freezing and freeze-drying (lyophilization) are two commonly used modes of preserving bone and soft tissue allografts. In 1985, a screened donor who was in the window of seronegativity underwent vascular organ and musculoskeletal tissue harvest. The bone and soft tissue procured underwent a variety of processing and preservation techniques. There have been no known cases of HIV transmission from the processed freeze-dried tissues. Evidence now exists that early HIV infection, before HIV antibody production, may be the most infectious period. The HIV antigen testing may allow earlier detection of an infectious donor, thus closing the window of seronegativity. It is unknown whether this nontransmission of HIV to the recipients of the processed and freeze-dried tissue was due to the processing or the nature of the tissue itself.

Ionic Dissolution Products of NovaBone® Promote Osteoblastic Proliferation via Influences on the Cell Cycle

“…The use of autografts is limited and bone harvesting, usually from the patient's own iliac crest, can be responsible for serious complications such as donor site morbidity and the need for further surgery. 1 The possible transmission of microbial agents from allografted bone to the recipient is greatly reduced by using a sterilization process, but it cannot be completely avoided. 1 The possibility, therefore, of transmission of diseases such as acquired immune deficiency syndrome still presents a great challenge, as well as the occurrence of immune reactions.…”

Effects of gamma irradiation on osteoinduction associated with demineralized bone matrix

“…4 Though allogeneic tissues are screened for infective diseases, sterilization methods, including aseptic collection and processing, electronic beam, heat, chemical sterilization like ethylene oxide gas, and gamma radiation, are often used prior to clinical use. 5,6 During the process of demineralized bone matrix preparation, by virtue of its exposure to concentrated acids such as HCl can be considered sterile.…”

Osteogenic protein 1 device increases bone formation and bone graft resorption around cementless implants

“…Morselized fresh frozen bone allograft (FFBA) from femoral heads, packed in the femoral canal or acetabulum, has been used successfully to treat de cient bone (McDonald et al 1988, Schreurs et al 1994, Hubble and Smith 1996, Benson et al 2000. However, bone allograft involves the risk of transmitting diseases (Asselmeier et al 1993, Salzman et al 1993, Sutherland et al 1997, adverse immunological response (Salzman et al 1993) and the supply is limited (Bos et al 1983, Goldberg et al 1984, Goldberg et al 1985, Sutherland et al 1997. Bone substitutes, such as tricalcium phosphates, calcium carbonates and hydroxyapatites have been marketed as substitutes for bone allograft.…”