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The Journal of Bone and Joint Surgery, Vol 77, Issue 2 214-224, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Transmission of the hepatitis-C virus by tissue transplantation
EU Conrad, DR Gretch, KR Obermeyer, MS Moogk, M Sayers, JJ Wilson and DM Strong
Northwest Tissue Center/Puget Sound Blood Center, Seattle, Washington.
The hepatitis-C virus has been the most prevalent cause of chronic
hepatitis in both blood and organ recipients. The introduction of a
second-generation immunoassay for antibodies to the hepatitis-C virus (HCV
2.0) provided the opportunity to determine if the hepatitis-C virus can be
transmitted through tissue transplantation. Banked sera from tissue donors
that had previously been found to be non-reactive to the first-generation
hepatitis-C virus antibody assay (HCV 1.0) and non-reactive for antibodies
to hepatitis-B core antigen were retested with HCV 2.0. The sera from two
donors were reactive; the transplant records of recipients of tissues from
these donors were reviewed, and the surgeons or hospitals were contacted.
The tissue recipients were tested with HCV 2.0, and positive sera were
tested for hepatitis-C virus RNA by polymerase chain reaction. Viral
nucleic acids isolated from viremic donors and recipients were analyzed for
identity by sequencing of the hepatitis-C virus envelope gene (E2)
hypervariable region. There were twenty-one grafts, which had been treated
with gamma radiation, from one donor; thirteen had been transplanted to
twelve recipients. Serum samples from six of the recipients were tested;
one was reactive. This patient had other risk factors for infection with
the hepatitis-C virus, and sequence analysis demonstrated non-identity
between the donor and recipient hepatitis-C virus isolates. Nine of twelve
grafts from a second donor had been transplanted in nine recipients. Serum
samples from five patients were tested with HCV 2.0; four were reactive. In
three of the four patients, the sera were determined to be positive for the
hepatitis-C virus by polymerase chain reaction. E2 sequence analyses of
hepatitis-C virus RNA isolates from two of these recipients demonstrated
sequence identity with the donor isolate. The results of the present report
demonstrate that the hepatitis-C virus can be transmitted by bone,
ligament, and tendon allografts. They also support the need for testing of
all tissue donors for antibodies to the hepatitis-C virus before the tissue
is released for transplantation. The results also suggest that seventeen
kilo-gray of gamma radiation may inactivate the hepatitis-C virus in
tissue.
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