Hepatitis C Virus Transmission to Organ and Tissue Recipients

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The summary below is from the full report titled "Transmission of Hepatitis C Virus to Several Organ and Tissue Recipients from an Antibody-Negative Donor." It is in the 1 November 2005 issue of Annals of Internal Medicine (volume 143, pages 648-654). The authors are B.D. Tugwell, P.R. Patel, I.T. Williams, K. Hedberg, F. Chai, O.V. Nainan, A.R. Thomas, J.E. Woll, B.P. Bell, and P.R. Cieslak.

What is the problem and what is known about it so far?

Transplantation of organs and tissues from healthy donors or cadavers (dead bodies) to people whose bodies have been damaged by disease, injury, or wear and tear has become a common part of medical practice. Organs such as kidneys, hearts, livers, and lungs, as well as tissues such as corneas, tendons, skin, and bones, are routinely transplanted. One cadaver can be the source of several donated organs and as many as 100 tissues (which can be stored for many months or years). Unfortunately, in addition to the potentially healing effects of transplantation, many serious disease agents can be transmitted from the donor to the recipient, such as hepatitis C virus (HCV), which is a leading and potentially fatal cause of chronic liver disease. An organ donor with HCV infection has a great risk for transmitting the virus to a recipient. On the other hand, HCV transmission has rarely been reported in patients who have received tissue transplants, and no transmissions have been reported when the donor has tested negative for infection by using up-to-date antibody assays. An even more sensitive method of detecting HCV infection in the donor consists of testing for the presence of components of the virus itself (HCV RNA), but this test is time-consuming and expensive and is not currently required by the U.S. Food and Drug Administration.

Why did the researchers do this particular study?

To find out whether the donor was the source of infection when a tissue transplant recipient developed HCV infection 6 weeks after transplantation. This was particularly important because the donor had been the source of 91 donated organs and tissues.

Who was studied?

The donor and all 40 individuals who had received organs or tissues.

How was the study done?

Investigators tested stored blood serum from the donor for HCV RNA. Serum from the recipients (taken both before and after transplantation) was subjected to both antibody and HCV RNA tests.

What did the researchers find?

Results of HCV antibody tests on blood taken from the donor before death had been negative for HCV infection, but the HCV RNA test result on stored blood was positive. Four recipients were found to have been infected with HCV before transplantation, and 1 recipient was infected with a strain of the virus that was different from the donor's (indicating that transplantation had not caused the infection). All 3 organ recipients and 5 of the tissue recipients were infected with HCV from the donor. No infections occurred in recipients of cornea, skin, or bone that had been sterilized with radiation. The remainder of the tissue that had not already been used was discarded.

What were the limitations of the study?

Serum samples were unavailable from 5 recipients after transplantation.

What are the implications of the study?

More stringent testing of donors may improve the safety of transplantation procedures.