Residual risk of infection with blood‐borne viruses in potential organ donors at increased risk of infection: systematic review and meta‐analysis

Abstract

Objective To estimate the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among people at increased risk of infection in Australia; to estimate the residual risk of infection among potential solid organ donors in these groups when their antibody and nucleic acid test results are negative. Study design Systematic review and meta‐analysis of reports of the incidence and prevalence of HIV, HCV, and HBV in groups at increased risk of infection in Australia. Data sources MEDLINE, government and agency reports, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, and National Health and Medical Research Council grants published 1 January 2000 – 14 February 2019; personal communications. Data synthesis Residual risk of HIV infection was highest among men who have sex with men (4.8 [95% CI, 2.7–6.9] per 10 000 antibody‐negative persons; 1.5 [95% CI, 0.9–2.2] per 10 000 persons who are both antibody‐ and nucleic acid‐negative). Residual risk of HCV infection was highest among injecting drug users (289 [95% CI, 191–385] per 10 000 antibody‐negative persons; 20.9 [95% CI, 13.8–28.0] per 10 000 antibody‐ and nucleic acid‐negative persons). Residual risk for HBV infection was highest among injecting drug users (98.6 [95% CI, 36.4–213] per 10 000 antibody‐negative people; 49.4 [95% CI, 18.2–107] per 10 000 persons who were also nucleic acid‐negative). Conclusions Absolute risks of window period viral infections are low in people from Australian groups at increased risk but with negative viral test results. Accepting organ donations by people at increased risk of infection but with negative viral test results could be considered as a strategy for expanding the donor pool. Registration International Prospective Register of Systematic Reviews (PROSPERO), CRD42017069820.

New blood‐borne virus infections among organ transplant recipients: An Australian data‐linked cohort study examining donor transmissions and other HIV, hepatitis C and hepatitis B notifications, 2000‐2015

“…Possible sources of viral infection recognized post transplant include re‐activated latent infection, 37 or newly acquired infection. Risk of unrecognized donor window‐period infection is very low 38 . Concerns from a biovigilance perspective about high rates of new virus notifications include the possibility of further late‐detected transmissions, particularly the 16 recipients from donors with viral infections who developed the same de novo infection more than 12 months after transplant.…”

TheMJAin 2019: going from very good to great!

“…These data are reassuring, as they confirm the renewed screening program is performing as expected. Organs are often rejected for transplantation if potential donors are at increased risk of blood‐borne virus infections, including men who have sex with men, injecting drug users, sex workers, and prisoners. Waller and her colleagues undertook a rigorous systematic review and meta‐analysis to estimate the residual risk in Australia of infection with human immunodeficiency virus (HIV) or hepatitis C (HCV) or B viruses (HBV) by organ donors from groups at increased risk who have negative viral test results. They found that the absolute residual risks of infection were very low, and that judicious acceptance of organs from such donors could reduce transplant waitlist mortality by providing organs for as many as 30 additional recipients each year in NSW alone. The Getting it Right Collaborative Group undertook an important validation study of a culturally adapted version of the nine‐item Patient Health Questionnaire (aPHQ‐9) as a screening tool for depression in Indigenous Australians.…”

Unexpected hepatitis B virus transmission after liver transplant from nucleic acid testing‐ and serology‐negative liver donors who are hepatitis C viremic

“…4 During the "serological window period," the blood and/or the donor organ can have the virus present with a negative serology, and can transmit the infection to the recipient. 8 This phenomenon led to the use of nucleic acid testing (NAT).…”