Document Type

Article

Original Publication Date

1992

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

326

Issue

11

First Page

726

Last Page

732

DOI of Original Publication

10.1056/NEJM199203123261102

Comments

Orignially published at http://dx.doi.org/10.1056/NEJM199203123261102

Date of Submission

January 2015

Abstract

Abstract

BACKGROUND

Since 1985, donors of organs or tissues for transplantation in the United States have been screened for human immunodeficiency virus type 1 (HIV-1), and more than 60,000 organs and 1 million tissues have been transplanted. We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative.

METHODS

We reviewed the processing and distribution of all the transplanted organs and tissues, reviewed the medical histories of the donor and HIV-1—infected recipients, tested stored donor lymphocytes for HIV-1 by viral culture and the polymerase chain reaction, and tested stored serum samples from four organ recipients for HIV-1 antigen and antibody.

RESULTS

HIV-1 was detected in cultured lymphocytes from the donor. Of 58 tissues and organs obtained from the donor, 52 could be accounted for by the hospitals that received them. Of the 48 identified recipients, 41 were tested for HIV-1 antibody. All four recipients of organs and all three recipients of unprocessed fresh-frozen bone were infected with HIV-1. However, 34 recipients of other tissues — 2 receiving corneas, 3 receiving lyophilized soft tissue, 25 receiving ethanol-treated bone, 3 receiving dura mater treated with gamma radiation, and 1 receiving marrow-evacuated, fresh-frozen bone — tested negative for HIV-1 antibody. Despite immunosuppressive chemotherapy, HIV-1 antibody appeared between 26 and 54 days after transplantation in the three organ recipients who survived more than 4 weeks.

CONCLUSIONS

Although rare, transmission of HIV-1 by seronegative organ and tissue donors can occur. Improvements in the methods used to screen donors for HIV-1, advances in techniques of virus inactivation, prompt reporting of HIV infection in recipients, and accurate accounting of distributed allografts would help to reduce further this already exceedingly low risk. (N Engl J Med 1992;326:726–32.)

Rights

From The New England Journal of Medicine, Simonds, R.J., Holmberg, S.D., Hurwitz, R.L., et al., Transmission of Human Immunodeficiency Virus Type 1 from a Seronegative Organ and Tissue Donor, Vol. 326, Page 726, Copyright © 1992 Massachusetts Medical Society. Reprinted with permission.

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