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Abstract Details
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
Transpl Infect Dis. 2020 Aug 7;e13437. doi: 10.1111/tid.13437. Online ahead of print.
Karen Mj Waller1, Nicole L De La Mata1, James A Hedley1, Brenda M Rosales12, Michael J O'Leary, Elena Cavazzoni3, Vidiya Ramachandran4, William D Rawlinson45, Patrick J Kelly1, Kate R Wyburn26, Angela C Webster17
Author information
1Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Sydney, 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, New South Wales, 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, Sydney, Australia.
Abstract
Background: Blood-borne viral infections can complicate organ transplantation. Systematic monitoring to distinguish donor-transmitted infections from other new infections post-transplant is challenging. Administrative health data can be informative. We aimed to quantify post-transplant viral infections, specifically those transmitted by donors, and those reactivating or arising new in recipients.
Methods: We linked transplant registries with administrative health data for all solid organ donor-recipient pairs in New South Wales, Australia, 2000-2015. All new recipient notifications of hepatitis B (HBV), C (HCV) or HIV after transplant were identified. Proven/probable donor-transmissions within 12 months of transplant were classified using an international algorithm.
Results: Of 2,120 organ donors, there were 72 with a viral infection (9/72 active, 63/72 past). These 72 donors donated to 173 recipients, of whom 24/173 already had the same infection as their donor, and 149/173 did not, so were at risk of donor-transmission. Among those at risk, 3/149 recipients had proven/probable viral transmissions (1 HCV, 2 HBV); none were unrecognised by donation services. There were no deaths from transmissions. There were no donor-transmissions from donors without known blood-borne viruses. An additional 68 recipients had new virus notifications, of whom 2/68 died, due to HBV infection.
Conclusion: This work confirms the safety of organ donation in an Australian cohort, with no unrecognised viral transmissions and most donors with viral infections not transmitting the virus. This may support targeted increases in donation from donors with viral infections. However, other new virus notifications post-transplant were substantial and are preventable. Data-linkage can enhance current biovigilance systems.