Tissue donation and virus safety: more nucleic acid amplification testing is needed

A. Pruss, G. Caspari, D.H. Krüger, J. Blümel, C.M. Nübling, L. Gürtler, W.H. Gerlich. Tissue donation and virus safety: more nucleic acid amplification testing is needed.
Transpl Infect Dis 2010: 12: 375–386. All rights reserved : In tissue and organ transplantation, it is of great importance to avo...

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Published in:Transplant infectious disease 2010-10, Vol.12 (5), p.375-386
Main Authors: Pruss, A., Caspari, G., Krüger, D.H., Blümel, J., Nübling, C.M., Gürtler, L., Gerlich, W.H.
Format: Article
Language:English
Subjects:
allograft
Blood Banks
Cadaver
Cost-Benefit Analysis
HBV
HCV
HIV
Humans
Living Donors
Nucleic Acid Amplification Techniques
nucleic acid amplification testing
nucleic acids
Tissue and Organ Procurement
tissue bank
Tissue Transplantation - adverse effects
Virus Diseases - prevention & control
Virus Diseases - transmission
virus safety
Viruses - isolation & purification
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Summary:A. Pruss, G. Caspari, D.H. Krüger, J. Blümel, C.M. Nübling, L. Gürtler, W.H. Gerlich. Tissue donation and virus safety: more nucleic acid amplification testing is needed.
Transpl Infect Dis 2010: 12: 375–386. All rights reserved : In tissue and organ transplantation, it is of great importance to avoid the transmission of blood‐borne viruses to the recipient. While serologic testing for anti‐human immunodeficiency virus (HIV)‐1 and ‐2, anti‐hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti‐hepatitis B core antigen (HBc), and Treponema pallidum infection is mandatory, there is until now in most countries no explicit demand for nucleic acid amplification testing (NAT) to detect HIV, hepatitis B virus (HBV), and HCV infection. After a review of reports in the literature on viral transmission events, tissue‐specific issues, and manufacturing and inactivation procedures, we evaluated the significance of HIV, HCV, and HBV detection using NAT  in  donors of various types of tissues and compared our results with the experiences of blood banking organizations. There is a significant risk of HIV, HCV, and HBV transmission by musculoskeletal tissues because of their high blood content and the high donor–recipient ratio. If no effective virus inactivation procedure for musculoskeletal tissue is applied, donors should be screened using NAT  for  HIV, HCV, and HBV. Serologically screened cardiovascular tissue carries a very low risk of HIV, HCV, or HBV transmission. Nevertheless, because effective virus inactivation is impossible (retention of tissue morphology) and the donor–recipient ratio may be as high as 1:10, we concluded that NAT  should be performed for HIV, HCV, and HBV as an additional safety measure. Although cornea allografts carry the lowest risk of transmitting HIV, HCV, and HBV  owing to corneal physiology, morphology, and the epidemiology of corneal diseases, NAT  for  HCV should still be performed. If the NAT  screening of a donor for HIV, HCV, and HBV is negative, quarantine storage of the donor tissue seems dispensable. In view of numerous synergistic effects with transfusion medicine, it would be advantageous for tissue banks to cooperate with blood bank laboratories in performing virological tests.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2010.00505.x