Background Less than 0.2 % of initially NAT(+) upon retesting are reported as NAT negative. However, there is a concern that these results could be caused by ultra-low viral loads associated with pre-ramp up phase of a “window” period. The ultra-low viral loads could produce an intermittent reactivity resulting in NAT(-) evaluation. This possibility has been recently underscored by reports of HCV transmission from HCV NAT(-) donors with no other HCV markers (Am J Transplant. 2015 Jul;15).

Aim To share our experience of the donor who was intermittently HCV NAT(+) but did not transmit HCV.

Donor 49y transgender, obese male with stable male partner, no history of re-assignment surgery, past hospitalizations, or IV drug abuse. The donor was hospitalized for altered mental status due to sepsis. He had multiple surgeries to remove fasciitis and clean wounds (multiple fasciotomies with debridement on groin and abdomen). He died of cardiac arrest. Early during hospitalization the donor received 12 units of packed red blood cells (PRBC) and 1 unit of PRBC on 12/24/15. The donor was not hemodiluted and tested for all required markers including IgM WNV, anti-T. cruzi and WNV/HIV/HCV/HBV using Ultrio TMA NAT (Grifols Diagnostic Solutions Inc., Emeryville). The laboratory findings were unremarkable and reported as HCV, HIV and HBV NAT negative. His heart and 2 kidneys were transplanted on 12/25/15. The lungs and liver were not recovered due to pneumonia and hepatomegaly.

Post transplant retrospective laboratory evaluations During routine post-transplant evaluation on 01/07/16 the heart recipient was found to be HCV(+). Subsequent testing by our laboratory of stored 3 plasmas and 3 sera revealed low HCV NAT(+) in 2 sera, 1 plasma and occasional HCV seropositivity for serum samples but not plasma samples. All donor specimens (after one freeze/thaw cycle) and post-transplant specimens from all organ recipients were sent to the CDC and found to be HCV non-reactive (NAT and serology).

Conclusions Analysis of laboratory data from the donor and recipients follow up was not supportive of a HCV transmission from the donor to the heart recipient. Moreover this case illustrates the proper recommendation that NAT non-repeatable but initially reactive donors should be reported as NAT negative.

CITATION INFORMATION: Nowicki M, Prince H, Chinchilla C, De Los Santos C, Trageser J, Stocks L. Ambiguous Nucleic Acid Tests (NAT) Results – Case of a Donor with Intermittent HCV NAT(+) but No HCV Transmission. Am J Transplant. 2017;17 (suppl 3).

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