Compliance with OPTN Infectious Disease Testing
Massachusetts General Hospital, Boston, MA
Meeting: 2022 American Transplant Congress
Abstract number: 596
Keywords: Hepatitis B, Hepatitis C, HIV virus, Outcome
Topic: Administrative » Administrative » 01 - Quality Assurance Process Improvement & Regulatory Issues
Session Name: Quality Assurance Process Improvement & Regulatory Issues
Session Type: Rapid Fire Oral Abstract
Date: Tuesday, June 7, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:40pm-6:50pm
Location: Hynes Room 206
*Purpose: Effective 3/1/21 OPTN policy requires all transplant recipients to have pre-transplant and post-transplant infectious disease testing performed at specific intervals: upon admission and prior to anastomosis for HIV antibody/antigen, HBVsAg, HBVcAb, HBVsAb, HCV antibody and HIV/HBV/HCV NAT testing; between 28 and 56 days after transplant for HIV/HCV/HBV NAT testing; and between 11-13 months after liver transplant for HBV NAT testing. Our Center wished to assess compliance with infectious disease testing and evaluate for any possible disease transmission to ensure recipients were treated in a timely manner.
*Methods: The Transplant Center in collaboration with Transplant ID, Hepatology, and Pharmacy conducted staff education and modified 2 clinical protocols for infectious disease tracking and treatment. The Quality and Compliance Team instituted an auditing/tracking process to ensure compliance with policies and adherence to therapy/monitoring. Database modifications included the creation of new order sets and a report for tracking infectious disease testing.
*Results: From 3/1/21 to 11/22/21 there were 223 patients transplanted (27 heart, 11 lung, 57 liver, 119 kidney, 1 kidney-pancreas, 1 pancreas, 1 heart/kidney, 1 heart/liver and 5 liver/kidney) of which admission labs revealed: 89.7% transplant recipients had complete serology/NAT testing performed on day 0;10.3% transplant recipients were missing at least one of the admission serological/NAT tests (HIV antibody, HBV DNA, HCV PCR, HIV viral load); one patient did not have labs drawn but testing was able to be conducted using other samples available in lab; 2 recipients converted their HBVcAb status from negative to positive; with repeat testing negative;1 recipient was noted to be HIV antibody/antigen positive confirmed with viral PCR on admission labs; 4 recipients were noted to be HBVsAg positive on admission labs with repeat testing negative; 2 recipients were noted to be HBV DNA positive (low level) on admission labs with repeat testing negative. Repeat follow-up testing at 28-56 days interval revealed: 2 recipients were noted to be HBV DNA positive (low level) on admission labs with repeat testing negative; 2 recipients converted their HBVcAb status from negative to positive; with repeat testing negative; 1 recipient was noted to be HCV viral load positive with repeat testing negative
*Conclusions: Through multi-disciplinary collaboration and a robust auditing/tracking system our Center was able to demonstrate nearly 90% compliance with infectious disease tracking on admission. Challenges to compliance include ensuring the correct order sets are being utilized on admission and follow-up labs are conducted within the appropriate timeframe. The modification of an HBV prophylaxis protocol provided a framework for the management of patients enhancing patient safety.
To cite this abstract in AMA style:Irwin L. Compliance with OPTN Infectious Disease Testing [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/compliance-with-optn-infectious-disease-testing/. Accessed March 26, 2023.
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