Contaminated Transplants

Contaminated Transplants

Eye, Kidney, Liver, Bone Marrow, Heart and Skin Products or Organs were a UK Hepatitis C risk, there were approximately 10,000 a year up until 1992. We lead with the Study below is based on French patients in a 1.2% Hepatitis C infected French population of donors to our 1.0% UK population prevalence.

The study by Peffault de Latour and colleagues provides important insights into this problem by careful follow-up of 96 hepatitis C virus (HCV)–infected survivors for up to 28 years. The cumulative incidence of cirrhosis was 24% at 20 years after transplantation, a remarkably high figure in comparison to the progression of HCV infection in nontransplantation patients. While genotype 3 and the presence of extrahepatic manifestations of HCV infection were related to development of cirrhosis, the hazard ratios were less than 2 for both factors.

As many as 35% of survivors from transplantation surgeries before 1992 may be infected with HCV. All survivors, particularly those from transplantation surgeries before 1992, must be tested for anti-HCV, staged by biopsy for extent of liver disease if infected. This is easier said than done. Some people are lost to follow-up. Others do not want their history of transplantation known to anyone.

The first step toward preventing the development of cirrhosis, however, is to emulate the practice of the Paris group by tracking all transplantation survivors and determining who is infected by HCV.

George B. McDonald

The special risks of bone marrow products were also properly investigated in France. In the UK we did not bother to ALT or anti HBc test our blood.

[Reduction of the post-transfusion hepatitis C risk in patients undergoing bone marrow allograft].

Norol F1, Roche B, Saint Marc Girardin MF, Kuentz M, Desforges L, Cordonnier C, Duedari N, Vernant JP.

Abstract

Post-transfusion hepatitis C incidence was studied in a series of patients with bone marrow allograft. The risk of HCV seroconversion was evaluated according to the date of grafting and the screening tests carried out in blood donors at this time. Anti-HCV antibodies were screened using Elisa tests of 2d generation and confirmed by Riba tests of 2d generation. Results were analysed. Out of 181 allografted patients from January 1987 to December 1991, 120 patients found anti-HCV negative prior to grafting, with at least six month post-transfusion follow-up were considered as evaluable in terms of HCV seroconversion. All these patients had received leucodepleted blood products and the most of them platelet unit concentrates. Prior to implementation of screening tests for non-A, non-B hepatitis, 14% of patients had seroconverted (0.44% per transfused product); after introduction of the screening for indirect markers (ALT) and for antibodies directed against the antigen of hepatitis B virus core (anti-HBc), the seroconversion incidence was 4% (0.26% per product). At the present time, since the implementation of anti-HCV screening tests, the risk has reached 1.6% (0.03% per transfused product). 6 patients out of 7 having seroconverted have been developing chronic hepatitis.

PMID: 7509605

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