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Letter to the Editors
Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation
Article first published online: 27 APR 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 15, Issue 5, page 561, May 2009
How to Cite
Ison, M. G. and Friedewald, J. J. (2009), Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation. Liver Transpl, 15: 561. doi: 10.1002/lt.21756
- Issue published online: 27 APR 2009
- Article first published online: 27 APR 2009
- Manuscript Accepted: 10 JAN 2009
- Manuscript Received: 10 DEC 2008
TO THE EDITORS:
We are writing in regard to a recently published article by Ahn and Cohen documenting the transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) to a liver recipient, 2 kidney recipients, and 1 heart recipient.1 The authors clearly present the case from their patients' perspective, allowing the transplant community to review many of the facts regarding their care. The authors state in the abstract and in the discussion that the transmission occurred secondary to the donor being within the window period between initial infection and detection of antibodies. This is factually incorrect because it has not been clearly confirmed and hemodilution may have contributed to the lack of detection. To date, confirmatory serologic and molecular testing has been conducted only on residual blood drawn on the donor post-transfusion. Because of legal proceedings, the pretransfusion blood has not had confirmatory serologic or molecular testing. Until this is done, it is impossible to determine whether the negative serologic testing that was reported to the centers at the time of the organ offer represented a true negative because the patient was in the window period or if the blood and fluids that the donor had received prior to specimen collection diluted the sample.
Second, an important recommendation from the 1994 Public Health Services Guidelines is not included in the discussion2: the need for posttransplant testing of all recipients of organs from increased-risk donors. This not only is an oversight in the article and in its accompanying editorial1, 3 but also is missing from most discussions on this topic. The guidelines clearly recommend that all recipients of organs from increased-risk donors “be tested for HIV immediately before transplantation and at 3 months following transplantation.” This case demonstrates some key issues to guide the testing of recipients. First, the patient, like the other transplant recipients, acquired HCV infection without seroconversion; as such, posttransplant testing should use both molecular and serologic methods. Second, although we cannot be sure that earlier testing would have affected the overall course of the patient, it is possible that early identification and treatment of the HIV and HCV infection in the recipient may have improved her outcome. Since the transmission event, at our center, we perform baseline serologic testing for HIV, hepatitis B virus, and HCV immediately preoperatively in all recipients of organs from increased-risk donors, and this is followed by serologic and molecular (quantitative polymerase chain reaction) testing for HIV, hepatitis B virus, and HCV, unless there was pretransplant documentation of protection or infection, at 1 and 3 months post-transplant. Such testing is just as important as the consent of recipients of organs from increased-risk donors. Finally, current Organ Procurement and Transplantation Network policy requires reporting of any donor-derived disease transmission if it is recognized to allow appropriate screening and care of other recipients.4
- 2Centers for Disease Control and Prevention. Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs. MMWR Recomm Rep 1994; 43(RR-8): 1–17.
- 4OPTN Policy 4.6. Available at: http://www.optn.org/sharedcontentdocuments/081231_evaluation_plan_policy_4_0.pdf. Accessed January 2009.
Michael G. Ison*, John J. Friedewald, * Divisions of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, Divisions of Nephrology, and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL.