New blood borne virus infections among organ transplant recipients: a data-linked cohort study examining transmitted and de novo hepatitis B, C and HIV infections
Karen Waller1, Nicole L De La Mata1, James A Hedley1, Brenda M Rosales1,2, Michael J O'Leary3, Elena Cavazzoni3, Vidiya Ramachandran4, William D Rawlinson4,5, Patrick J Kelly1, Kate R Wyburn2,6, Angela C Webster1,7.
1Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia; 2Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia; 3New South Wales Organ and Tissue Donation Service, Sydney, Australia; 4Serology and Virology Division, NSW Health Pathology Randwick Prince of Wales Hospital, Randwick, Australia; 5Schools of SOMS, BABS and Women’s and Children’s, University of NSW, Sydney, Australia; 6Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia; 7Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
Introduction: Blood borne virus (BBV) infections can complicate organ transplantation. Systematic monitoring to distinguish donor-transmitted infection from de novo post-transplant infection is challenging. Additional information can be obtained through linkage of administrative health data.
Aims: We aimed to identify donor-transmitted and de novo BBV infections among organ transplant recipients.
Methods: Cohort study of all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. Donor and recipient BBV infections were identified by linking transplant registries with administrative health data. Proven/probable donor-transmissions were identified among new recipient infections within 12 months of transplant, classified according to an international algorithm. All other new BBV infections were classified as de novo infections.
Results: Of 2,120 organ donors, there were 73 with a BBV infection (11/73 active, 62/73 past). Donors with BBV donated to 176 recipients, of whom 24/176 had the same BBV as their donor, and 152/176 did not; these 152 recipients were at risk of donor-transmission. Among those at risk, there were 3/152 proven/probable BBV transmissions (1 hepatitis C [HCV], 2 hepatitis B [HBV]) and 149/152 recipients with non-transmissions. All donor-transmissions were previously recognised by donation services, and were from donors with known BBV. There were no deaths from transmissions. There were 70 recipients with de novo BBV, of whom 2/70 died from new HBV.
Conclusion: This work confirms the safety of Australian organ donation, with no unrecognised BBV transmissions and many non-transmissions from donors with BBV. This may support increasing targeted donation from donors with BBV. However, de novo BBV infections were substantial and preventable. Data-linkage may be a useful adjunct to current biovigilance systems.
NSW Ministry of Health. NHMRC Postgraduate Scholarship GNT1168202.
There are no comments yet...
