October 5, 2013
SAN FRANCISCO — Two recipients of organs from a single donor developed hepatitis C infection that was traced back to the donor, who was negative for the disease by nucleic acid testing, according research presented here at ID Week 2013.
“Antibody detection of hepatitis C typically takes 7 to 10 weeks, and RNA detection with nucleic acid testing takes 3 to 7 days, but this may vary by test sensitivity and hemodilution of specimen,” Emily Blumberg, MD, professor of medicine at Perelman School of Medicine at the University of Pennsylvania, said during her presentation. “In 2013, the US Public Health Service updated their guidelines, recommending that HCV antibody and nucleic acid testing be performed on all organ donors.”
Two organ recipients were reported to the CDC in March 2012 with newly-diagnosed HCV infections identified by routine, post-transplantation nucleic acid testing and screening. In December 2011, both had received organs — heart and left kidney — from one donor, an active injection drug user who had undetectable HCV by polymerase chain reaction.
Donor specimens underwent repeat HCV nucleic acid testing at the CDC. Donor serum was taken 4 days before transplant and donor splenocytes, which were archived for HLA typing, were taken the day of the transplant. The CDC also performed repeat nucleic acid testing on archived and fresh serum from all organ recipients, according to investigators.
The repeat genotyping of HCV in the left kidney and heart recipients identified genotype 2b HCV. Although the serum from the donor repeated a negative test, the splenocytes taken from the donor on the day of transplant tested positive for HCV RNA, also genotype 2b. Blumberg said this suggests that the donor had a very recent HCV infection, and that there was a clear molecular relationship between the HCV in the donor and the recipients, which shared an uncommon genotype.
“HCV transmission should be considered from increased-risk donors, even with the most sensitive laboratory screening,” Blumberg said. “It is important to obtain informed consent of recipients about the possibility of disease transmission from increased-risk donors, even when the nucleic acid testing is negative.”
Blumberg also said that the time lag between donor HCV nucleic acid testing and transplantation should be minimized in increased-risk donor cases, and that post-transplant HCV testing protocols of the recipients of these organs should be implemented.