Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, GA.
Division of Healthcare Quality and Promotion, Office of Blood, Organ and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA.
Am J Transplant. 2015 Jul;15(7):1827-35. doi: 10.1111/ajt.13283. Epub 2015 May 5.
Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors.
核酸检测（NAT）用于丙型肝炎病毒（HCV）的筛查，适用于器官捐献者，但并非所有捐献者的感染都能被检测到。我们描述了三起美国丙型肝炎病毒传播事件，涉及具有更高感染风险的捐献者。我们查阅了捐献者和受者的病历，并对新感染的受者进行了访谈。如果在从高风险捐献者获取的器官移植后，受者新检出感染，则认为是供者源性 HCV 感染。使用高灵敏度定量 PCR 检测储存的供者血清和组织样本中的 HCV RNA。对移植后和移植前的受者血清进行 HCV RNA 检测。利用高变区 1 的准种分析来确定受者 HCV 变异体的遗传相关性。每个捐献者在死亡前均有使用注射毒品的证据。在 12 名受者中，有 8 名 HCV 感染-6 名在移植后新诊断。在器官采集时收集的供者免疫组织的储存样本中，回溯性检测到 HCV RNA。系统进化分析显示，来自受者的 HCV 变体具有两个密切相关的簇。这些调查结果确定了首例已知的来自具有阴性 NAT 筛查的高风险器官捐献者的 HCV 传播事件，表明供者感染非常新近。在考虑高风险捐献者时，受者知情同意和移植后血液传播病原体的筛查是必不可少的。
