Donor‐derived hepatitis C in the era of increasing intravenous drug use: A report of the Disease Transmission Advisory Committee

Abstract

The opioid epidemic has resulted in a potential increase in donors in the testing window period for hepatitis C virus (HCV). We analyzed HCV reports to the Disease Transmission Advisory Committee (DTAC) between 2008 and 2016 to estimate the risk of HCV transmission. In 15 of 95 (16%) reports, at least one recipient developed proven/probable donor-derived HCV resulting in 32 infected recipients. Seven transmissions occurred during the nucleic acid testing (NAT) window period; four occurred during serological window period. The other four transmission occurred due to human error (3) and false-negative serology (1). All seronegative-exposed liver and lung recipients contracted HCV; 18/21 (86%) kidney and 3/4 (75%) heart recipients developed HCV. Four transmitting donors died of intravenous drug overdose, three in 2016 and one in 2012. Among donors with a history of intravenous drug use (IVDU), drug intoxication as a mechanism of death, or increased risk status, and negative screening HCV testing, the risk of transmission to a recipient was about 1 in 1000. The overall risk of transmitting HCV from NAT-negative donors with IVDU is low and consistent with modeling data. This information may be helpful to clinicians counseling potential recipients offered these organs.

Ten years of donor-derived disease: A report of the disease transmission advisory committee

“…Hepatitis C virus (HCV) was the leading viral pathogen with 24 reported donors transmitting unexpected HCV. Details regarding HCV transmissions (expected HCV transmissions were excluded) have been previously published 18 . The 10 reports of unexpected CMV transmission reflected either human error or false negative donor serologic results.…”

“…Although for many DDDs all organ recipients are at risk and a high rate of penetrance among exposed recipients has been observed (eg, HCV and Strongyloides ), 6,9,18 lung recipients are disproportionately at risk for certain DDI. With 1 exception, only lung recipients developed DDI with community respiratory virus, Mycoplasma , and Aspergillus .…”

Donor heart selection: Evidence-based guidelines for providers

“…Recommendation regarding donors with tuberculosis: 208 (See Table 6.) Recommendation regarding donors with increased infection risk: 127,193,[209][210][211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226] (See also Recommendations regarding emerging viral pathogens: [227][228][229][230][231][232][233][234][235][236][237][238][239][240][241][242][243] (See Table 8.) Recommendations regarding central nervous system (CNS) infections in the donor: 253,254 (See Table 10.)…”

Impact of the OPTN transmissible diseases policy and US PHS increased risk donor guidelines on living donor candidates

“…Further, data from 2008 to 2016 demonstrated 15 deceased donors with proven or probable HCV transmission; three were the result of human error, 11 were window period infections, and one had false negative serology; all but one had a history of intravenous drug use or drug intoxication. 21 Likewise, the Centers for Disease Control and Prevention recently presented data on transplants from seven deceased donors (15 recipients) that resulted in HBV and nine deceased donors (31 recipients) resulting in HCV transmissions. Almost all deceased donors in these transmission events had engaged in at least one increased risk behavior (7/7 of the HBV+ donors; 7/9 HCV+ donors).…”