Quality control processes in allografting: A twenty-year retrospective review of a hospital-based bone bank in Taiwan

Abstract

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher’s exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991–2001); and 18.4% and 1.25% in the second decade (2001–2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases.

Challenges for quality control of institutional bone banking in developing countries

“…Surgical site infection (SSI) as a repercussion of the contaminated bone allograft is uncommon and ranges between 1.3% and 12%. 1,8,9 The overall allograft-related infection rate after 13 years of bone banking was 1.80%. The organism most commonly identified was the Staphylococcus spp in both audits.…”

Exploring the Role of Intraoperative Positive Culture of Allograft Bone in Subsequent Postoperative Infections among Donors and Recipients in Bone Bank Processing

“…Allografts are frequently used in orthopedic reconstructive procedures, and successful outcomes after allograft implantation depend on the quality control of bone bank processing. The bone bank can store allografts from living or cadaveric donors and safely supply them for recipients, and must prevent the transmission of infectious diseases and malignancies through routine culture swabs and serological screening [ 2 , 4 , 5 , 7 ]. However, there are no uniform guidelines for the management of bone banks, and most bone bank protocols for quality control follow the guidelines recommended by the American Association of Tissue Banks and also meet the national law standards [ 1 , 3 , 6 , 14 , 15 , 16 ].…”

“…The overall positive bacterial culture rate of after-thawing allografts before implantation ranged from 1% to 12%, and the infection rate in recipients with contaminated allograft was reported as being from 0% to 10% [ 1 , 2 , 5 , 6 , 11 , 12 , 13 ]. However, the infective pathogens of postoperative surgical site infections were different from the cultured microorganisms of thawed allografts [ 1 , 2 , 5 , 6 , 11 , 12 , 13 ]. Sims et al reported that 43 implanted allografts (43/996, 4.3%) had positive bacterial growth, and significant postoperative infection developed in two patients (4.6%) [ 1 ].…”

“…Bone allografts are frequently used in surgery, providing a structural framework and osteoconduction in many orthopedic procedures, including revision knee and hip arthroplasty, spine surgery, acute fracture with bone loss, and nonunions [ 1 , 2 , 3 ]. Bone allografts can be obtained from living or deceased donors and then stored in a bone bank; however, the operative procedures from retrieval to transplantation must be performed under aseptic conditions and a hygienic environment to prevent bacterial contamination [ 1 , 3 , 4 , 5 ].…”

Allograft versus autograft for reconstruction after resection of primary bone tumors: a comparative study of long-term clinical outcomes and risk factors for failure of reconstruction

“…The disadvantages of allograft include reducing osteogenicity and osteoconductivity due to processing and the risk of disease transmission 3 , 9 . For the best outcomes, bone allografts from organ donors should include a strict allograft process (namely, well-controlled harvesting, packaging, and storage in a bone bank) and optimal size-matching between the donor and host at the time of surgery 10 , 11 .…”