Hepatitis C infection in cadaver organ donors: strategies to reduce transmission of infection and prevent organ waste
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- Pereira, B.J.G. & Levey, A.S. Pediatr Nephrol (1995) 9(Suppl 1): S23. doi:10.1007/BF00867679
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The transmission of hepatitis C virus (HCV) by organ transplantation has been unequivocally demonstrated. Among recipients of organs from anti-HCV-positive donors, 57%–96% test positive for HCV RNA. Consequently, several organ procurement organizations have adopted a policy restricting the use of anti-HCV-positive donors to life-saving transplants (heart, liver, or lung). The differences in the rate of transmission of HCV infection by anti-HCV-positive donors could be related to the prevalence of HCV RNA among these donors. In a national collaborative study of 3,078 cadaver organ donors from eight organ procurement organizations in the United States, the prevalence of anti-HCV antibodies and HCV RNA were 4.2% and 2.4% respectively. The sensitivity and negative predictive value of anti-HCV antibodies for HCV RNA were 100%. However, despite a specificity of 98.1%, the positive predictive value was only 55.1%. Discarding organs from enzyme-linked immunosorbent assay 2-positive donors would eliminate transmission, but organs from 1.88% of donors would be wasted. Clinical and laboratory characteristics did not distinguish anti-HCV-positive donors with and without HCV RNA. Hence, to reduce waste it is necessary to develop confirmatory tests with a higher specificity for HCV RNA than those that are currently available. Even if anti-HCV-positive but HCV RNA-negative donors could be identified and utilized, 2.4% of cadaver organ donors that test positive for serum HCV RNA would remain unsuitable for transplantation of non-lifesaving organs. Hence, several authors have suggested the use of kidneys from anti-HCV-positive donors in recipients with pre-existing HCV infection. In a preliminary report from Spain, there were no differences in the post-transplantation prevalence of liver disease, graft or patient survival between anti-HCV-positive renal transplant recipients who received organs from anti-HCV-positive donors and those receiving organs from anti-HCV-negative donors. However, larger long-term studies are required to confirm the safety of such transplants. The impact of each of the above policies on organ discard, transmission of HCV, and acquisition of new infection after transplantation are discussed in this review.