The high-risk donor: viral infections in solid organ transplantation.
OBJECTIVE
Recently, four organ recipients were infected with HIV through transplantation, raising questions about current serologic testing policies. Currently, the decision to use enzyme-linked immunosorbent assay or nucleic acid testing, an expensive and time-consuming method capable of detecting more recent infections, is left up to individual organ procurement organizations. The purpose of this review was to present estimates of the window period between infection and detection by enzyme-linked immunosorbent assay and nucleic acid testing for HIV, hepatitis B virus, and hepatitis C virus; and to evaluate the impact of those infections on posttransplant outcomes.


RESULTS
Nucleic acid testing for HIV can detect infections 12-13 days earlier than enzyme-linked immunosorbent assay; in the case of hepatitis B virus, infections are detected 21.8-36 days earlier; and in the case of hepatitis C virus, infections are detected 26-60 days earlier. Studies indicate that it is possible to manage all three infections posttransplant. HIV/hepatitis C virus coinfections seem to present the greatest posttransplant management challenges due to drug toxicities.


CONCLUSIONS
Nucleic acid testing can reduce the window period and thus increase the probability of detecting viral infections. HIV, hepatitis B virus, and hepatitis C virus positive organs may be appropriate for use in some situations; nucleic acid testing helps patients and physicians make informed decisions about their use.
Singer
Andrew L
AL
Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA.
Kucirka
Lauren M
LM
Namuyinga
Ruth
R
Hanrahan
Colleen
C
Subramanian
Aruna K
AK
Segev
Dorry L
DL
D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005820:Genetic Testing; D015658:HIV Infections / Q000175:diagnosis / Q000209:etiology; D006509:Hepatitis B / Q000175:diagnosis / Q000209:etiology; D006526:Hepatitis C / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D014777:Virus Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy / Q000635:transmission
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral