MULTIORGAN DONOR TRANSMISSION OF HEPATITIS-C VIRUS TO 5 SOLID-ORGAN TRANSPLANT RECIPIENTS AND LACK OF TRANSMISSION TO CORNEAL TRANSPLANT RECIPIENTS

Background: A multi-organ donor seronegative for hepatitis C virus (HC V) by 1st generation enzyme immunoassay (EIA) supplied 5 solid organs and 2 corneas to 7 recipients. This donor was retrospectively shown to be 2nd generation HCV EIA-positive and polymerase chain reaction (PCR )-positive. All 5 solid organ recipients but none of the corneal recip ients developed HCV infection. Objectives: To demonstrate the discorda nce between serological and PCR-based HCV detection in solid organ tra nsplant recipients and the lack of transmission of HCV to the two corn eal transplant recipients. Study design: All 5 solid organ recipients were retrospectively shown to be HCV PCR-negative and -seronegative pr e-transplant and HCV PCR-positive post-transplant. Serial serum sample s on 3 recipients were evaluated by 2nd generation EIA, a prototypic s tructural and non-structural dual bead assay (EIA-SA, Abbott), the Chi ron Recombinant Immunoblot Assay, 2nd generation (RIBA-2), and the Chi ron RIBA HCV Test System Strip Immunoblot Assay 3.0 (RIBA-3, Chiron). Results: The dual bead EIA-SA and RIBA-3 were able to detect HCV seroc onversion approximately 6 months earlier than the 2nd generation EIA i n 2 recipients, and in 1 recipient only PCR detected infection within the first 10 months. There was no evidence of HCV transmission to the corneal recipients. Conclusions: Although third generation assays such as the RIBA-3 and EIA-SA narrowed the window of HCV seronegativity in transplant recipients compared with the 2nd generation EIA, PCR was t he most sensitive method of detecting acute HCV infection. Despite tra nsmission of HCV to all of the solid organ recipients HCV was not tran smitted to the corneal transplant recipients.