Barna D. Tugwell, MD; Priti R. Patel, MD, MPH; Ian T. Williams, PhD, MS; Katrina Hedberg, MD, MPH; Feng Chai, PhD; Omana V. Nainan, PhD; Ann R. Thomas, MD, MPH; Judith E. Woll, MD; Beth P. Bell, MD, MPH; Paul R. Cieslak, MD
Note: This paper was presented in part at the 42nd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, California, 27–30 September 2002, and the Society for Healthcare Epidemiology of America Annual Scientific Meeting, Arlington, Virginia, 5–8 April 2003. Preliminary data are presented in Hepatitis C virus transmission from an antibody-negative organ and tissue donor—United States, 2000-2002. MMWR Morb Mortal Wkly Rep. 2003;52:273-4, 276. [PMID: 12729075]
Acknowledgments: The authors thank Harriet Homan, RN, for her assistance in case investigations and specimen collection; David N. Gilbert, MD, Christopher L. Corless, MD, PhD, and Scott Kemeny, MD, for their case reporting and clinical assistance; Wendi Kuhnert, PhD, and Tracy L. Greene, BS, for their laboratory work; Daniel Jernigan, MD, MPH, and Marion Kainer, MD, MPH, for their epidemiologic consultation; Karen Kiang, MD, and others in state and local health departments for their assistance in data and specimen collection; Mark Smith, CTBS, for his overall assistance with the investigation; and William E. Keene, PhD, MPH, for his assistance in creating the figures.
Grant Support: In part by the Emerging Infections Program Cooperative Agreement between the Oregon Department of Human Services and the Centers for Disease Control and Prevention.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Barna D. Tugwell, MD, Division of General Medicine, Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, 406 Bethune Building, Halifax, Nova Scotia B3H 2Y9, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Tugwell: Division of General Medicine, Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, 406 Bethune Building, Halifax, Nova Scotia B3H 2Y9, Canada.
Dr. Patel: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E68, Atlanta, GA 30333.
Drs. Williams, Chai, Nainan, and Bell: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G37, Atlanta, GA 30333.
Drs. Hedberg, Thomas, and Cieslak: Oregon Department of Human Services, 800 NE Oregon Street, Suite 772, Portland, OR 97232.
Dr. Woll: Community Blood Center/Community Tissue Services, 349 South Main Street, Dayton, OH 45402-2715.
Author Contributions: Conception and design: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, A.R. Thomas, P.R. Cieslak.
Analysis and interpretation of the data: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, F. Chai, O.V. Nainan, J.E. Woll, B.P. Bell, P.R. Cieslak.
Drafting of the article: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, O.V. Nainan, B.P. Bell.
Critical revision of the article for important intellectual content: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, O.V. Nainan, A.R. Thomas, J.E. Woll, B.P. Bell, P.R. Cieslak.
Final approval of the article: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, A.R. Thomas, J.E. Woll, B.P. Bell, P.R. Cieslak.
Provision of study materials or patients: B.D. Tugwell, P.R. Patel, J.E. Woll.
Statistical expertise: B.D. Tugwell, I.T. Williams, K. Hedberg.
Administrative, technical, or logistic support: B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, O.V. Nainan, P.R. Cieslak.
Collection and assembly of data: B.D. Tugwell, P.R. Patel, O.V. Nainan, J.E. Woll.
Although hepatitis C virus (HCV) transmission through tissue transplantation has been rarely reported, a donor with undetected viremia may infect several recipients. A patient developed acute hepatitis C shortly after tissue transplantation. Ninety-one tissues or organs had been recovered from the donor.
To determine whether the donor was the source of infection and the extent of transmission to other organ and tissue recipients.
Descriptive epidemiologic study; serum testing for HCV infection.
Recipients were located in 16 states and 2 other countries.
Donor and graft recipients.
Hepatitis C virus infection was defined as the presence of anti-HCV or HCV RNA. The authors determined the genetic relatedness of viral isolates from the donor and recipients by genotype comparison and quasi-species analysis.
The donor was anti-HCV–negative but was HCV RNA–positive (genotype 1a). Forty persons received transplants during 22 months. Five persons were HCV-infected before transplantation or had a genotype other than 1a, and 5 persons had no post-transplantation serum specimens available. Of the remaining 30 recipients, HCV infection occurred in 8 recipients: 3 of 3 organ recipients, 1 of 2 saphenous vein recipients, 1 of 3 tendon recipients, and 3 of 3 tendon with bone recipients. These 8 recipients had viral isolates genetically related to those of the donor. No cases occurred in recipients of skin (n = 2), cornea (n = 1), or irradiated bone (n = 16).
Post-transplantation serum specimens were unavailable for 5 recipients.
An anti-HCV–negative donor was the source of HCV infection for 8 recipients of organs or tissues. Although HCV transmission from anti-HCV–negative donors is probably uncommon, changes in donor screening to include routine testing for HCV RNA merit further consideration to improve the safety of transplantation.
Transmission of hepatitis C virus (HCV) infection as a result of tissue transplantation has not been previously reported from donors testing negative with a second- or third-generation enzyme immunoassay.
Stored tissues (3 organs and 27 tissues) from an anti-HCV–negative donor (by second-generation immunoassay) were transplanted into 30 recipients known to have been HCV negative before transplantation. Five tissue recipients and all 3 organ recipients were infected with HCV.
In view of the large number of potential recipients from a single tissue donor, HCV RNA testing of donors may improve the safety of organ and tissue transplantation.
Transplantation of grafts from a donor with hepatitis C virus (HCV) infection, by month of transplantation and case status (n= 38), United States, 2000–2002.
Table. Classification of Graft Recipients from a Hepatitis C Virus–Infected Donor, United States, 2000–2002
Unrooted phylogenetic tree of hypervariable region sequences of graft donor, graft recipients, and selected Third National Health and Nutrition Examination Survey (NHANES III) participants, United States, 2000–2002.
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Barna D. Tugwell, Priti R. Patel, Ian T. Williams, Katrina Hedberg, Feng Chai, Omana V. Nainan, et al. Transmission of Hepatitis C Virus to Several Organ and Tissue Recipients from an Antibody-Negative Donor. Ann Intern Med. 2005;143:648–654. doi: 10.7326/0003-4819-143-9-200511010-00008
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Published: Ann Intern Med. 2005;143(9):648-654.
Gastroenterology/Hepatology, Infectious Disease, Viral Hepatitis.
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