Re-assessing the risk of undetected HBV, HCV and HIV in deceased tissue and living surgical bone donors in England

Abstract

Testing of living surgical bone and deceased tissue donors by NHS Blood and Transplant (NHSBT) has included individual donation (ID) nucleic acid testing (NAT) for HBV, HCV and HIV since 2008. Here, the well-established window period methodology was used to estimate residual risk (RR). Prevalence of viral markers was calculated among both tissue donor populations. Incidence was derived by adjusting incidence among new blood donors by the prevalence ratio for tissue and new blood donors. Residual risk (RR) was calculated as the product of incidence and duration of WP for single donor HBV NAT at 0.058 years (21 days), HCV NAT at 0.008 years (3 days) and HIV NAT at 0.014 (5 days). Between 2013 and 2017, 7886 living surgical bone donors were tested, 16 were positive for markers of HBV, HCV and HIV. HCV had the highest prevalence at 114/100,000 donors. Incidence and RR was highest for HBV at 3.55/100,000-person years and 0.32/100,000 donors (95% CI 0.11/100,000–1.42/100,000). Among 9751 deceased tissue donors tested, 22 were positive for viral markers. HBV had highest prevalence at 174/100,000 donors, and the highest incidence and RR at 8.12/100,000 person years and 0.74/100,000 donors (95% CI 0.08/100,000–2.99/100,000). Using ID NAT, RR of not detecting a HBV, HCV and HIV WP donation among tissue donors is less than 1/100,000 donors. These estimates provide a good starting point for discussing potential risks of viral transmission through tissue transplant with patients.