Transmission of Hepatitis C Virus from an Organ Donor with Undetectable Viremia by Nucleic Acid Testing

Infectious Disease Week (IDWeek)
October 2-6, 2013
San Francisco, Ca

630. Transmission of Hepatitis C Virus from an Organ Donor with Undetectable Viremia by Nucleic Acid Testing

Session: Oral Abstract Session: Infections in Transplantations and Immunocompromised

Friday, October 4, 2013: 9:30 AM

Room: The Moscone Center: 220-226

Background: Nucleic acid testing (NAT) is used for screening hepatitis C virus (HCV) infection among solid organ donors. On March 9, 2012 two organ recipients were reported to the Centers for Disease Control and Prevention with newly diagnosed HCV infections on routine post-transplant screening. Despite active injection drug use (IDU), the donor had undetectable HCV by polymerase chain reaction (PCR) testing. A public health investigation was initiated to determine the sources of HCV transmission.

Methods: The following donor and recipient specimens were tested by RNA quantitative PCR for HCV: donor’s serum, donor splenocytes from organ recovery; and recipients’ pre-and post-transplant serum. HCV genomic sequencing and quasispecies analysis were used to measure relatedness of HCV. Medical records were reviewed and recipients were interviewed for HCV-related risk factors. Epidemiologic investigations into source of transmission included assessment of healthcare exposures. 

Results: HCV RNA was undetectable by PCR and anti-HCV was negative by enzyme immunoassay on donor serum, but HCV genotype 2b was isolated from donor splenocytes procured at organ recovery, 4 days after serum collection. HCV genotype 2b was newly isolated by PCR in the left kidney recipient (day 9 post-transplant) and the heart recipient (day 30 post-transplant); two other recipients had chronic HCV infection before transplant. Quasispecies analysis showed close relatedness between HCV strains from the left kidney and heart recipients, indicating a common source; comparison to the donor’s HCV strains is ongoing. The donor’s IDU and recent plasma transfusion were identified as HCV-related risks. Trace-back of transfused units is ongoing; no other sources have been identified.

Conclusion: We report the first known transmission of HCV infection from an organ donor with negative screening by NAT, indicating very recent donor infection. These findings highlight the importance of communicating transmission risk to recipients, despite the most sensitive available donor screening. Donor-derived transmission of HCV and standardized recipient follow-up testing should be considered in recipients of organs procured from donors with behavioral risks for blood-borne pathogens.

Anil Suryaprasad, MD¹, Susan N. Hocevar, MD², Lauren Torso, MPH³, Jan Drobeniuc, MD, PhD¹, Yury Khudyakov, PhD¹, David Pegues, MD, FIDSA, FSHEA⁴, Matthew J. Kuehnert, MD, FIDSA² and Emily Blumberg, MD, FIDSA⁵, (1)Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Healthcare Quality and Promotion, Office of Blood, Organ, and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA, (3)Pennsylvania Department of Health, Harrisburg, PA, (4)University of Pennsylvania Health System, Philadelphia, PA, (5)Medicine, University of Pennsylvania Health System, Philadelphia, PA

Disclosures:

A. Suryaprasad, None

S. N. Hocevar, None

L. Torso, None

J. Drobeniuc, None

Y. Khudyakov, None

D. Pegues, None

M. J. Kuehnert, None

E. Blumberg, None

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