Evaluation of serological screening of cadaveric sera for donor selection for cornea transplantation

Human corneas are explanted for grafting as late as 72 h after death, for e xample, from medical examiner cases. Currently, infection of the donor with human immunodeficency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) is excluded in most cornea banks by serological testing of th e cadaveric serum only. The reliability of this strategy was investigated b y testing paired cadaveric and premortem sera of 33 potential donors. Resul ts were discordant in 17 of 33 donors by at least one assay. Most frequentl y, HBsAg enzyme-linked immunosorbent assay (ELISA) yielded false-positive r esults with the cadaveric serum (16 of 33 serum pairs). Virus safety of the graft was affected in a single case, which was HCV antibody negative in th e cadaveric serum, but positive in the premortem serum (confirmed by HCV-RI BA strip immunoassay). Forensic DNA profiling by polymerase chain reaction (PCR) of both serum samples confirmed that these were derived from the same individual. In conclusion, the results indicate that serological testing o f cadaveric sera is not a reliable method for screening of potential cornea donors, and may not be sufficient for the virus safety of cornea grafts. T herefore, other screening strategies such as detection of viral nucleic aci ds by PCR should be evaluated. (C) 1999 Wiley-Liss, Inc.