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Residual risk of infection with blood‐borne viruses in potential organ donors at increased risk of infection: systematic review and meta‐analysis

Karen MJ Waller, Nicole L De La Mata, Patrick J Kelly, Vidiya Ramachandran, William D Rawlinson, Kate R Wyburn and Angela C Webster
Med J Aust 2019; 211 (9): . || doi: 10.5694/mja2.50315
Published online: 14 October 2019

Abstract

Objective: To estimate the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among people at increased risk of infection in Australia; to estimate the residual risk of infection among potential solid organ donors in these groups when their antibody and nucleic acid test results are negative.

Study design: Systematic review and meta‐analysis of reports of the incidence and prevalence of HIV, HCV, and HBV in groups at increased risk of infection in Australia.

Data sources: MEDLINE, government and agency reports, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, and National Health and Medical Research Council grants published 1 January 2000 – 14 February 2019; personal communications.

Data synthesis: Residual risk of HIV infection was highest among men who have sex with men (4.8 [95% CI, 2.7–6.9] per 10 000 antibody‐negative persons; 1.5 [95% CI, 0.9–2.2] per 10 000 persons who are both antibody‐ and nucleic acid‐negative). Residual risk of HCV infection was highest among injecting drug users (289 [95% CI, 191–385] per 10 000 antibody‐negative persons; 20.9 [95% CI, 13.8–28.0] per 10 000 antibody‐ and nucleic acid‐negative persons). Residual risk for HBV infection was highest among injecting drug users (98.6 [95% CI, 36.4–213] per 10 000 antibody‐negative people; 49.4 [95% CI, 18.2–107] per 10 000 persons who were also nucleic acid‐negative).

Conclusions: Absolute risks of window period viral infections are low in people from Australian groups at increased risk but with negative viral test results. Accepting organ donations by people at increased risk of infection but with negative viral test results could be considered as a strategy for expanding the donor pool.

Registration: International Prospective Register of Systematic Reviews (PROSPERO), CRD42017069820.


  • 1 University of Sydney, Sydney, NSW
  • 2 NSW Health Pathology, Prince of Wales Hospital and Community Health Services, Sydney, NSW
  • 3 University of New South Wales, Sydney, NSW
  • 4 Royal Prince Alfred Hospital, Sydney, NSW
  • 5 Sydney Medical School, University of Sydney, Sydney, NSW
  • 6 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW


Correspondence: kwal0672@uni.sydney.edu.au

Acknowledgements: 

We thank Jenny Iversen and Hamish McManus, who contributed by personal communication unpublished data that were included in our meta‐analysis. Karen Waller is funded by a National Health and Medical Research Council Postgraduate Scholarship (APP1168202).

Competing interests:

No relevant disclosures.

  • 1. Organ and Tissue Authority. Australian donation and transplantation activity report 2018. Feb 2019. https://donatelife.gov.au/file/1765/download?token=DCH5rpBf (viewed May 2019).
  • 2. International Registry in Organ Donation and Transplantation (IRODaT). Final numbers 2017. Updated Dec 2018. http://www.irodat.org/img/database/pdf/IRODaT%20Newsletter%202017.pdf (viewed May 2019).
  • 3. Australia and New Zealand Organ Donation Registry (ANZOD). Australian waiting list. Updated Feb 2019. https://www.anzdata.org.au/anzod/reports/organ-waiting-list (viewed May 2019).
  • 4. Cass A, Chadban S, Gallagher M, et al. The economic impact of end‐stage kidney disease in Australia: projections to 2020. Sydney: Kidney Health Australia, 2010. https://kidney.org.au/cms_uploads/docs/kha-economic-impact-of-eskd-in-australia-projections-2020.pdf (viewed May 2019).
  • 5. Waller K, Rosales B, Thomson I, et al. Donor referrals at increased risk for blood borne viruses in New South Wales, 2010–2015 [abstract]. Transplantation Society of Australia and New Zealand annual scientific meeting, Brisbane, 7–9 May 2017. Transplant Direct 2017; 3 (10 Suppl 1): S14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636211/pdf/txd-3-s1.pdf (viewed May 2019).
  • 6. Kucirka LM, Namuyinga R, Hanrahan C, et al. Provider utilization of high‐risk donor organs and nucleic acid testing: results of two national surveys. Am J Transplant 2009; 9: 1197–1204.
  • 7. Pruett TL, Clark MA, Taranto SE. Deceased organ donors and PHS risk identification: impact on organ usage and outcomes. Transplantation 2017; 101: 1670–1678.
  • 8. Trotter P, Summers D, Robb M, et al. Deceased organ donor with a history of increased risk behaviour for the transmission of blood‐borne viral infection: the UK experience. Transplantation 2017; 101: 1679–1689.
  • 9. Bowring MG, Holscher CM, Zhou S, et al. Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys. Am J Transplant 2018; 18: 617–624.
  • 10. Kizilbash SJ, Rheault MN, Wang Q, et al. Kidney transplant outcomes associated with the use of increased risk donors in children. Am J Transplant 2019; 19: 1684–1692.
  • 11. Ison MG. Nucleic acid testing of organ donors: is the glass half empty or half full? Am J Transplant 2015; 15: 1743–1745.
  • 12. Kucirka LM, Sarathy H, Govindan P, et al. Risk of window period HIV infection in high infectious risk donors: systematic review and meta‐analysis. Am J Transplant 2011; 11: 1176–1187.
  • 13. Kucirka LM, Sarathy H, Govindan P, et al. Risk of window period hepatitis‐C infection in high infectious risk donors: systematic review and meta‐analysis. Am J Transplant 2011; 11: 1188–1200.
  • 14. Transplantation Society of Australia and New Zealand. Clinical guidelines for organ transplantation from deceased donors, version 1.2. Updated Dec 2018. https://www.tsanz.com.au/Clinical%20Guidelines%20-Dec%202018.pdf (viewed May 2019).
  • 15. Dolan K, MacDonald M, Silins E, Topp L. Needle and syringe programs: a review of the evidence. Canberra: Australian Department of Health and Ageing, 2005. https://www.health.gov.au/internet/main/publishing.nsf/content/83AAED699516CE2DCA257BF0001E7255/$File/evid.pdf (viewed May 2019).
  • 16. Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Policy Manag 2014; 3: 123–128.
  • 17. Humar A, Morris M, Blumberg E, et al. Nucleic acid testing (NAT) of organ donors: is the “best” test the right test? A consensus conference report. Am J Transplant 2010; 10: 889–899.
  • 18. Kirby Institute. HIV, viral hepatitis and sexually transmissible infection in Australia: annual surveillance report 2017. Sydney: Kirby Institute, UNSW, 2017. https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_Annual-Surveillance-Report-2017_compressed.pdf (viewed May 2019).
  • 19. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, June quarter 2016. 15 Dec 2016. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/6DAF7F7C4A59465DCA25808900122564/$File/31010_jun%202016.pdf (viewed May 2019).
  • 20. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2016. Sydney: Kirby Institute, UNSW, 2016. https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_Annual-Surveillance-Report-2016_UPD170627.pdf (viewed May 2019).
  • 21. The CST/CNTRP increased risk donor working group. Guidance on the use of increased infectious risk donors for organ transplantation. Transplantation 2014; 98: 365–369.
  • 22. Grulich AE, Guy R, Amin J, et al; Expanded PrEP Implementation in Communities New South Wales (EPIC‐NSW) research group. Population‐level effectiveness of rapid, targeted, high‐coverage roll‐out of HIV pre‐exposure prophylaxis in men who have sex with men: the EPIC‐NSW prospective cohort study. Lancet HIV 2018; 5: e629–e637.
  • 23. Medland NA, Chow EPF, Read THR, et al. Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013–2017) but not in the newly‐arrived Asian‐born. BMC Infect Dis 2018; 18: 410.
  • 24. Iversen J, Dore G, Catlett B, et al. Association between rapid utilisation of direct hepatitis C antivirals and decline in the prevalence of viremia among people who inject drugs in Australia. J Hepatol 2019; 70: 33–39.
  • 25. Heard S, Iversen J, Geddes L, Maher L. Australian Needle Syringe Program Survey national data report 2014–2018: prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: Kirby Institute, UNSW Sydney, 2019. https://kirby.unsw.edu.au/sites/default/files/kirby/report/ANSPS_National-Data-Report-2014-2018.pdf (viewed July 2019).
  • 26. Goldberg DS, Abt PL, Blumberg EA, et al. Trial of transplantation of HCV‐infected kidneys into uninfected recipients. N Engl J Med 2017; 376: 2394–2395.
  • 27. Australian Technical Advisory Group on Immunisation. Recommended vaccines for people before and after a solid organ transplant. In: ATAGI. Australian immunisation handbook. Canberra: Australian Department of Health, 2018. Updated 5 June 2018. https://immunisationhandbook.health.gov.au/resources/handbook-tables/table-recommended-vaccines-for-people-before-and-after-a-solid-organ (viewed July 2019).
  • 28. Kadatz K, Klarenbach S, Gill J, Gill JS. Cost‐effectiveness of using kidneys from hepatitis C nucleic acid test‐positive donors for transplantation in hepatitis C‐negative recipients. Am J Transplant 2018; 18: 2457–2464.
  • 29. Gupta G, Zhang Y, Carrol NV, Sterling RK. Cost‐effectiveness of hepatitis C‐positive donor kidney transplantation for hepatitis C‐negative recipients with concomitant direct‐active antiviral therapy. Am J Transplant 2018; 18: 2496–2505.
  • 30. Palacios G, Druce J, Du L, et al. A new arenavirus in a cluster of fatal transplant‐associated diseases. N Engl J Med 2008; 358: 991–998.
  • 31. Martinez MC, Kok CC, Baleriola C, et al. Investigation of occult hepatitis B virus infection in anti‐HBc positive patients from a liver clinic. PLoS One 2015; 10: e0117275.
  • 32. Yuen MF, Chen DS, Dusheiko GM, et al. Hepatitis B virus infection. Nat Rev Dis Primers 2018; 4: 18035.

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