Dutch Martin J, Seed Clive R, Cheng Anthea, Kiely Philip, Patrick Cameron J, Opdam Helen I, Knott Jonathan C
Emergency Department, Royal Melbourne Hospital, Melbourne, Australia.
Department of Critical Care, University of Melbourne, Melbourne, Australia.
Transplant Direct. 2023 Feb 17;9(3):e1447. doi: 10.1097/TXD.0000000000001447. eCollection 2023 Mar.
Unexpected donor-derived infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are rare but important potential complications of deceased organ transplantation. The prevalence of recently acquired (yield) infections has not been previously described in a national cohort of Australian deceased organ donors. Donor yield infections are of particularly significance, as they can be used to gain insights in the incidence of disease in the donor pool and in turn, estimate the risk of unexpected disease transmission to recipients.
We conducted a retrospective review of all patients who commenced workup for donation in Australia between 2014 and 2020. Yield cases were defined by having both unreactive serological screening for current or previous infection and reactive nucleic acid testing screening on initial and repeat testing. Incidence was calculated using a yield window estimate and residual risk using the incidence/window period model.
The review identified only a single yield infection of HBV in 3724 persons who commenced donation workup. There were no yield cases of HIV or HCV. There were no yield infections in donors with increased viral risk behaviors. The prevalence of HBV, HCV, and HIV was 0.06% (0.01-0.22), 0.00% (0-0.11), and 0.00% (0-0.11), respectively. The residual risk of HBV was estimated to be 0.021% (0.001-0.119).
The prevalence of recently acquired HBV, HCV, and HIV in Australians who commence workup for deceased donation is low. This novel application of yield-case-methodology has produced estimates of unexpected disease transmission which are modest, particularly when contrasted with local average waitlist mortality. http://links.lww.com/TXD/A503.
乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）的意外供体源性感染虽罕见，但却是已故器官移植重要的潜在并发症。此前尚未在澳大利亚已故器官供体的全国队列中描述近期获得性（产出）感染的患病率。供体产出感染具有特别重要的意义，因为它们可用于深入了解供体库中的疾病发病率，进而估计意外疾病传播给受者的风险。
我们对2014年至2020年期间在澳大利亚开始进行捐赠检查的所有患者进行了回顾性研究。产出病例的定义为当前或既往感染的血清学筛查无反应，且初次和重复检测时核酸检测筛查有反应。发病率采用产出窗口估计法计算，残余风险采用发病率/窗口期模型计算。
该回顾在3724名开始进行捐赠检查的人中仅发现1例HBV产出感染。未发现HIV或HCV产出病例。病毒风险行为增加的供体中没有产出感染。HBV、HCV和HIV的患病率分别为0.06%（0.01 - 0.22）、0.00%（0 - 0.11）和0.00%（0 - 0.11）。HBV的残余风险估计为0.021%（0.001 - 0.119）。
在开始进行已故捐赠检查的澳大利亚人中，近期获得性HBV、HCV和HIV的患病率较低。这种产出病例方法学的新应用得出的意外疾病传播估计值较低，尤其是与当地平均等待名单死亡率相比时。http://links.lww.com/TXD/A503
