Characteristics of deceased solid organ donors and screening results for hepatitis B, C, and human immunodeficiency viruses — United States, 2010–2017

Abara, Winston E.; Collier, Melissa G.; Moorman, Anne C.; Bixler, Danae; Jones, Jefferson M.; Annambhotla, Pallavi; Bowman, James S.; Levi, Marilyn E.; Brooks, John T.; Basavaraju, Sridhar V.

doi:10.1111/ajt.15284

Cited by 17 publications

(25 citation statements)

References 11 publications

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“…Given the rise of HCV Ab+ donors in the United States based on available national data, the addition of DAA agents to our therapeutic arsenal has allowed us to explore the utilization of these increased risk organs . The transplant community underwent a similar transformation for hepatitis B core antibody positive liver grafts in the past decade.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C‐positive donor liver transplantation for hepatitis C seronegative recipients

Ting

Hamilton

Gürakar

et al. 2019

Transplant Infectious Dis

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ribonucleic acid; SVR12, sustained virologic response at 12 weeks after treatment; ULN, upper limit of normal. AbstractBackground: The opioid crisis has led to an increase in hepatitis C virus-positive donors in the past decade. Whereas historically hepatitis C seropositive organs were routinely discarded, the advent of direct-acting antiviral agents has notably expanded the utilization of organs from donors with hepatitis C. There has been growing experience with liver transplantation (LT) from hepatitis C seropositive donors to hepatitis C seropositive recipients. However, data remain limited on LT from hepatitis C seropositive or hepatitis C ribonucleic acid positive donors to hepatitis C seronegative recipients. Methods:We performed a retrospective study of 26 hepatitis C seronegative recipients who received hepatitis C seropositive donor livers followed by preemptive antiviral therapy with direct-acting antiviral treatment at the Johns Hopkins Hospital Results: Twenty-five of the 26 recipients are alive with proper graft function; 20 of them received livers from hepatitis C nucleic acid testing positive donors. All 12 recipients who completed their direct-acting antiviral courses and have reached sufficient follow-up for sustained virologic response have achieved sustained virologic response. Nine of our recipients have either completed direct-acting antiviral treatment without sufficient follow-up time for sustained virologic response or are undergoing direct-acting antiviral treatment. One patient is awaiting antiviral treatment initiation pending insurance approval. Of note, 11 of 12 patients with sustained virologic response received a hepatitis C nucleic acid testing positive donor liver.Conclusion: Hepatitis C seronegative patients who receive a hepatitis C seropositive or hepatitis C nucleic acid testing positive liver allograft can enjoy good short-term outcomes with hepatitis C cure following direct-acting antiviral treatment.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C‐positive donor liver transplantation for hepatitis C seronegative recipients

Ting

Hamilton

Gürakar

et al. 2019

Transplant Infectious Dis

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“…We found that 0.2% had a positive HIV antibody, 0.7% had a positive HBV surface antigen, 7.5% had a positive HBV core antibody, and 7.3% had a positive HCV antibody result. These rates are significantly higher than those from actual deceased organ donors: 0% HIV Ab, 0.1% HBsAg, 4.8% HBcAb, and 5.3% HCV Ab ( P < .0001) 20…”

Section: Discussionmentioning

confidence: 70%

Utilization of deceased organ donors based on HIV, hepatitis B virus, and hepatitis C virus screening test results

Theodoropoulos

Kroll‐Desrosiers

Ison

2020

Transplant Infectious Dis

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Background Potential deceased organ donors are screened for human immunodeficiency virus (HIV‐1), hepatitis B virus (HBV), and hepatitis C virus (HCV) with serologic tests and nucleic acid tests (NATs). The results of these tests on the utilization of donors have not been directly measured. Methods Twenty‐six organ procurement organizations (OPOs) provided primary HIV, HBV, and HCV screening results and utilization information for donor referrals evaluated from 2004 to 2017. Additional information regarding donor organ utilization was obtained from the Organ Procurement and Transplantation Network database. Data were analyzed using logistic regression. Results Test results were submitted for 38 166 potential deceased organ donors; 31 (0.1%) were HIV NAT‐negative but seropositive, 5.2% were HBV core antibody‐positive and NAT‐negative, while 1.8% were HCV antibody‐positive and NAT‐negative. Organ utilization of HBV and/or HCV NAT‐negative organs increased over time despite positive antibody status. Conclusions Nucleic acid test detected infections in seronegative donors, especially for HCV. The use of NAT for deceased donor screening correlated with increased utilization of donor organs.

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“…Donors with one or more risk factors are designated as increased risk donors (IRDs) per these recommendations. Due largely to the current US opioid crisis, a growing number and proportion of organ donors are IRDs, increasing from 8.9% in 2010 to 26.3% in 2017 12 . Because HHV‐8 infection shares risk factors with HIV, HBV, and HCV infection, increasing numbers of IRD may elevate the risk of donor‐derived HHV‐8 and development of KS.…”

Section: Introductionmentioning

confidence: 99%

Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior

Dollard

Annambhotla

Wong

et al. 2021

American Journal of Transplantation

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Kaposi sarcoma (KS) can develop following organ transplantation through reactivation of recipient human herpesvirus 8 (HHV‐8) infection or through donor‐derived HHV‐8 transmission. We describe 6 cases of donor‐derived HHV‐8 infection and KS investigated from July 2018 to January 2020. Organs from 6 donors, retrospectively identified as HHV‐8‐positive, with a history of drug use disorder, were transplanted into 22 recipients. Four of 6 donors had risk factors for HHV‐8 infection reported in donor history questionnaires. Fourteen of 22 organ recipients (64%) had evidence of posttransplant HHV‐8 infection. Lung recipients were particularly susceptible to KS. Four of the 6 recipients who developed KS died from KS or associated complications. The US opioid crisis has resulted in an increasing number and proportion of organ donors with substance use disorder, and particularly injection drug use history, which may increase the risk of HHV‐8 transmission to recipients. Better awareness of the risk of posttransplant KS for recipients of organs from donors with HHV‐8 infection risk could be useful for recipient management. Testing donors and recipients for HHV‐8 is currently challenging with no validated commercial serology kits available. Limited HHV‐8 antibody testing is available through some US reference laboratories and the Centers for Disease Control and Prevention.

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Characteristics of deceased solid organ donors and screening results for hepatitis B, C, and human immunodeficiency viruses — United States, 2010–2017

Abstract: This report summarizes the increasing use of increased‐risk deceased organ donors, noting the association of HCV and HBV with this designation.

Cited by 17 publications

References 11 publications

Hepatitis C‐positive donor liver transplantation for hepatitis C seronegative recipients

Hepatitis C‐positive donor liver transplantation for hepatitis C seronegative recipients

Utilization of deceased organ donors based on HIV, hepatitis B virus, and hepatitis C virus screening test results

Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior

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