Hepatitis C RNA prevalence in a Western European organ donor pool and virus transmission by organ transplantation

Abstract

Summary. Liver disease is a common finding after organ transplantation and might in part be due to transmission of hepatitis C virus (HCV). The aim of this study was to determine the prevalence of positive results with different anti-HCV tests and HCV-RNA in a local donor pool and to clarify to what extent HCV was transmitted to organ recipients. Serum samples from 207 consecutive organ donors were analysed retrospectively with anti-HCV ELISA (2nd and 3rd generation), anti-HCV RIBA (2nd generation) and HCV polymerase chain reaction (PCR). Organ recipients at risk were identified and followed up serologically and clinically.Anti-HCV seroprevalance in organ donors was 4.3 YO for 2nd generation ELISA, 4-8 Yo for 3rd generation ELISA and 1.9 YO for 2nd generation RIBA. HCV-PCR was positive in 1.4 YO. Nine organs from four RIBA-positive donors were transplanted into eight recipients of whom four became anti-HCV and PCR positive after transplantation. HCV-PCR became positive several days after transplantation whereas anti-HCV seroconversion took place after 8-9 months. Two recipients developed acute liver disease and another two showed features of mild chronic liver disease but no serious complications due to HCV infection were observed.

Expanding the donor pool for liver transplantation

“…First, there was a concern that grafts with HCV would be damaged and would not perform well after transplantation. Second, there is an obvious risk of transmitting HCV to the recipient through transplantation of the infected graft [51,52]. However, several centers have shown that selected HCV-infected livers may be successfully transplanted into patients with HCV-induced liver disease.…”

“…In addition, HCV infection is common in the donor pool, with 1.4% to 3% of organ donors testing positive for HCV (by the HCV polymerase chain reaction test) [51,52]. Donor livers infected with HCV have traditionally been discarded for two reasons.…”

Treatment of hepatitis B and C following nonliver organ transplants

“…The prevalence of anti-HCV in potential organ donors in North America and Europe is approximately 2% [36,37], more than five times that in healthy blood donors, reflecting a direct association between high-risk behaviors and premature death. Almost 20% of anti-HCV-positive donors will be RNA negative [38].…”

Virologically compromised donor grafts in liver transplantation

“…Since the discovery and cloning of HCV [56,57], several studies have documented a risk of HCV infection among recipients of organs from HCV infected donors [58][59][60][61].…”