Introduction of Universal Hepatitis E RNA Screening in Deceased Organ Donors – The UK Experience
1NHS Blood and Transplant, London, United Kingdom, 2Royal Infirmary of Edinburgh, Edinburgh, United Kingdom, 3Royal Liverpool University Hospital, Liverpool, United Kingdom, 4University Hospitals Coventry and Warwickshire, Coventry, United Kingdom, 5Public Health England, Leeds, United Kingdom, 6Public Health England, London, United Kingdom
Meeting: 2019 American Transplant Congress
Abstract number: D240
Session Information
Session Name: Poster Session D: Non-Organ Specific: Viral Hepatitis
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: We aim to describe the strategy and initial results of post-donation, universal screening of deceased organ donors in the UK. HEV RNA is tested for shortly after transplantation, hence results are not used to inform donor suitability but to guide appropriate management of recipients. The UK Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) recommended universal HEV RNA screening of donors of blood, tissues, haematopoietic cells and solid organs and this was implemented by NHS Blood and Transplant in 2017. This is a unique opportunity for acquisition of knowledge on donor-derived transmission of HEV in solid organ transplantation.
*Methods: Plasma samples are tested individually in the qualitative Procleix® HEV assay (Griffols Diagnostic Solutions); quantification is done in the AmpliCube®HEV assay (Mikrogen Diagnostik). The Wantai® HEV IgG and IgM assays (Fortress Diagnostics) are used for serology. The ORF2 gene is the target for genotyping and phylogenetic analysis.
*Results: Circa 2000 deceased organ donors were screened in the first year. Two donors had confirmed HEV viraemia with negative HEV IgG and IgM, denoting early infection. All recipients (2 livers and 4 kidneys) in both clusters developed a de novo infection with HEV genotype 3c virus. Phylogenetic analysis of at least two viral strains from each cluster enabled comparison and documentation of a common source of infection in both clusters. Four out of six recipients developed persistent infections and required Ribavirin treatment. They are currently being followed up.
*Conclusions: The incidence of acute HEV infection in the UK has declined in recent years. The rates in the English blood donors went from 1:2800 in 2012 down to 1:4500 in 2018. Notably, the observed incidence in deceased organ donors is around one per 1000 donors. We will continue to monitor trends and outcomes. Detection of donor viraemia triggers notification of transplant centres and prompt testing and monitoring of recipients. Our initial experience demonstrates that despite low levels of plasma viraemia in the donor, transmission through solid organs in the early phases of infection is very efficient. A 100% transmission rate with 66% persistency has been observed so far, justifying a strategy of post-transplant donor HEV testing in order to identify transmission events and initiate appropriate intervention.
To cite this abstract in AMA style:
Ushiro-Lumb I, Tettmar K, Johannessen I, Simpson K, Hart I, Timms J, Hale A, Ijaz S, Tedder R, Forsythe J. Introduction of Universal Hepatitis E RNA Screening in Deceased Organ Donors – The UK Experience [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/introduction-of-universal-hepatitis-e-rna-screening-in-deceased-organ-donors-the-uk-experience/. Accessed November 25, 2024.« Back to 2019 American Transplant Congress