Recently Acquired Blood-borne Virus Infections in Australian Deceased Organ Donors: Estimation of the Residual Risk of Unexpected Transmission

Martin J Dutch; Clive R Seed; Anthea Cheng; Philip Kiely; Cameron J Patrick; Helen I Opdam; Jonathan C Knott

doi:10.1097/TXD.0000000000001447

Recently Acquired Blood-borne Virus Infections in Australian Deceased Organ Donors: Estimation of the Residual Risk of Unexpected Transmission

Transplant Direct. 2023 Feb 17;9(3):e1447. doi: 10.1097/TXD.0000000000001447. eCollection 2023 Mar.

Authors

Martin J Dutch^{1

2}, Clive R Seed^{3

4}, Anthea Cheng³, Philip Kiely⁵, Cameron J Patrick⁶, Helen I Opdam^{7

8}, Jonathan C Knott^{1

2}

Affiliations

¹ Emergency Department, Royal Melbourne Hospital, Melbourne, Australia.
² Department of Critical Care, University of Melbourne, Melbourne, Australia.
³ Clinical Services and Research, Australian Red Cross Blood Service, Perth, Australia.
⁴ Medical School, University of Western Australia, Perth, Australia.
⁵ Department of Clinical Services and Research, Australian Red Cross Blood Service, Melbourne, Australia.
⁶ Statistical Consultancy Centre, University of Melbourne, Melbourne, Australia.
⁷ Intensive Care Unit, Austin Hospital, Melbourne, Australia.
⁸ The Australian Organ and Tissue Authority, Canberra, Australia.

Abstract

Unexpected donor-derived infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are rare but important potential complications of deceased organ transplantation. The prevalence of recently acquired (yield) infections has not been previously described in a national cohort of Australian deceased organ donors. Donor yield infections are of particularly significance, as they can be used to gain insights in the incidence of disease in the donor pool and in turn, estimate the risk of unexpected disease transmission to recipients.

Methods: We conducted a retrospective review of all patients who commenced workup for donation in Australia between 2014 and 2020. Yield cases were defined by having both unreactive serological screening for current or previous infection and reactive nucleic acid testing screening on initial and repeat testing. Incidence was calculated using a yield window estimate and residual risk using the incidence/window period model.

Results: The review identified only a single yield infection of HBV in 3724 persons who commenced donation workup. There were no yield cases of HIV or HCV. There were no yield infections in donors with increased viral risk behaviors. The prevalence of HBV, HCV, and HIV was 0.06% (0.01-0.22), 0.00% (0-0.11), and 0.00% (0-0.11), respectively. The residual risk of HBV was estimated to be 0.021% (0.001-0.119).

Conclusions: The prevalence of recently acquired HBV, HCV, and HIV in Australians who commence workup for deceased donation is low. This novel application of yield-case-methodology has produced estimates of unexpected disease transmission which are modest, particularly when contrasted with local average waitlist mortality. Supplemental Visual Abstract; http://links.lww.com/TXD/A503.