In the Journals

Rates of deceased donor organs with HCV, HBV, HIV increasing in US

Between 2010 and 2017, the number and percentage of deceased donor organs with a transmissible infectious disease — such as hepatitis C, hepatitis B or HIV — increased in the U.S., which may likely be tied to the ongoing opioid epidemic, according to a recent report from the CDC.

“These findings demonstrate the continuing need for identifying viral bloodborne pathogen infection risk factors among deceased donors to reduce the risk for transmission, monitor posttransplant infection in recipients, and offer treatment if infection occurs,” Winston E. Abara, MD, from the Division of Viral Hepatitis at the CDC, and colleagues wrote.

Abara and colleagues analyzed deceased donor data from 2010 to 2017 for both standard risk donors (SRDs) and increased risk donors (IRDs).

During this period, the proportion of IRDs increased approximately 200% (from 8.9% to 26.3%; P < .001), the proportion of drug intoxication as the cause of mortality increased by approximately 200% (from 4.3% to 13.4%; P < .001), and the proportion of donors with reported injection drug use increased by approximately 500% (from 1.3% to 8%; P < .001).

Among all deceased donors, HBV surface antigen positivity remained constant (0.1%), total HBV core antibody positivity decreased slightly (5% vs. 4.7%), anti-HCV positivity increased (4.2% vs. 7.3%), and anti-HIV positivity increased slightly (0% vs. 0.1%) during the study period.

The researchers observed no substantial changes in HBsAg or anti-HBc positivity among IRDs during the study period. However, anti-HCV positivity increased (15.9% vs. 21.6%).

From 2014 to 2017, the percentage of IRDs tested by HCV, HBV and HIV nucleic acid amplification increased from 4.6% to more than 99.9% for all three infections.

“Because universal donor NAT testing has been implemented since 2014, reduction of the 12-month period for IRD designation to a shorter interval warrants further consideration,” the researchers wrote. “Although this study does not assess the use of donor organs, modifications to current recommendations might increase their use while still protecting recipient safety. These modifications include shortening the 12-month interval to reduce the proportion of donors categorized as IRDs and reassessment of terminology that might currently be contributing to underuse of these organs.”

While the number of deceased SRDs increased from 7,226 to 7,580 during the study period, the percentage decreased from 90.1% to 73.7% (P < .001).

Among SRDs, HBsAg positivity remained constant (0.1%), whereas anti-HBc (4.7% vs. 3.9%) and anti-HCV positivity decreased (3% vs. 2.2%).

From 2014 to 2017, the percentage of SRDs tested by HCV NAT increased from 3.4% to 100% and by HBV or HIV NAT by 3.3% to 100%, despite no current recommendation for SRDs to be screened by HBV or HIV NAT.

Compared with SRDs, IRDs were significantly more likely to be anti-HBc-positive (7% vs. 4.3%; P < .001), HBV DNA-positive (0.4% vs. 0.1%; P < .001), anti-HCV-positive (19.1% vs. 2.3%; P < .001), and HCV RNA-positive (14.9% vs. 1.2%; P < .001).

“Given advances in technology and universal NAT implementation among solid organ donors, CDC and [Health Resources and Services Administration] will continue to work with partners to review the current guideline recommendations to assess opportunities for refinement to reduce transmission of viral bloodborne pathogens and increase donor organ use,” Abara and colleagues concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

Between 2010 and 2017, the number and percentage of deceased donor organs with a transmissible infectious disease — such as hepatitis C, hepatitis B or HIV — increased in the U.S., which may likely be tied to the ongoing opioid epidemic, according to a recent report from the CDC.

“These findings demonstrate the continuing need for identifying viral bloodborne pathogen infection risk factors among deceased donors to reduce the risk for transmission, monitor posttransplant infection in recipients, and offer treatment if infection occurs,” Winston E. Abara, MD, from the Division of Viral Hepatitis at the CDC, and colleagues wrote.

Abara and colleagues analyzed deceased donor data from 2010 to 2017 for both standard risk donors (SRDs) and increased risk donors (IRDs).

During this period, the proportion of IRDs increased approximately 200% (from 8.9% to 26.3%; P < .001), the proportion of drug intoxication as the cause of mortality increased by approximately 200% (from 4.3% to 13.4%; P < .001), and the proportion of donors with reported injection drug use increased by approximately 500% (from 1.3% to 8%; P < .001).

Among all deceased donors, HBV surface antigen positivity remained constant (0.1%), total HBV core antibody positivity decreased slightly (5% vs. 4.7%), anti-HCV positivity increased (4.2% vs. 7.3%), and anti-HIV positivity increased slightly (0% vs. 0.1%) during the study period.

The researchers observed no substantial changes in HBsAg or anti-HBc positivity among IRDs during the study period. However, anti-HCV positivity increased (15.9% vs. 21.6%).

From 2014 to 2017, the percentage of IRDs tested by HCV, HBV and HIV nucleic acid amplification increased from 4.6% to more than 99.9% for all three infections.

“Because universal donor NAT testing has been implemented since 2014, reduction of the 12-month period for IRD designation to a shorter interval warrants further consideration,” the researchers wrote. “Although this study does not assess the use of donor organs, modifications to current recommendations might increase their use while still protecting recipient safety. These modifications include shortening the 12-month interval to reduce the proportion of donors categorized as IRDs and reassessment of terminology that might currently be contributing to underuse of these organs.”

While the number of deceased SRDs increased from 7,226 to 7,580 during the study period, the percentage decreased from 90.1% to 73.7% (P < .001).

Among SRDs, HBsAg positivity remained constant (0.1%), whereas anti-HBc (4.7% vs. 3.9%) and anti-HCV positivity decreased (3% vs. 2.2%).

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From 2014 to 2017, the percentage of SRDs tested by HCV NAT increased from 3.4% to 100% and by HBV or HIV NAT by 3.3% to 100%, despite no current recommendation for SRDs to be screened by HBV or HIV NAT.

Compared with SRDs, IRDs were significantly more likely to be anti-HBc-positive (7% vs. 4.3%; P < .001), HBV DNA-positive (0.4% vs. 0.1%; P < .001), anti-HCV-positive (19.1% vs. 2.3%; P < .001), and HCV RNA-positive (14.9% vs. 1.2%; P < .001).

“Given advances in technology and universal NAT implementation among solid organ donors, CDC and [Health Resources and Services Administration] will continue to work with partners to review the current guideline recommendations to assess opportunities for refinement to reduce transmission of viral bloodborne pathogens and increase donor organ use,” Abara and colleagues concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.