Doctors should routinely screen for evidence of viral RNA—genetic evidence of the hepatitis virus—to reduce the risk of disease transmission during liver and other organ transplants. That's the opinion of a team of doctors in France who published a study about virus RNA screening late last year in the journal The Lancet.1
A More Sensitive Screening Test
Viral RNA screening is more sensitive than the more conventional serologic screening, a blood test done to determine the presence of antibodies that occurs because of viral infection. Testing for the presence of blood antibodies to viral diseases like HIV and hepatitis C is the conventional method to determine whether it's safe for an individual to donate organs, involving either a living donor or a cadaver donor.2
By contrast, viral RNA screening is done through a special blood test to detect a virus' genetic material. That more sensitive test would benefit recipients of organ transplants in cases in which donors don't have obvious signs of disease, says Jean-Michel Pawlotsky, MD, PhD, chief of the virology unit in the department of Bacteriology and Virology at Henri Mondor University Hospital in Creteil, France, and his colleagues.
"Our data, together with the reported cases of HCV transmission to recipients from a seronegative HCV RNA-positive donor, suggest that routine screening of organ and tissue donors might increase viral safety in the transplantation setting," Pawlotsky explained.
A patient classified as seronegative means that they haven't yet developed detectable antibodies to a viral infection, even though the infection has already occurred. Testing for evidence of viral RNA, therefore, is more effective for someone who is seronegative because it can warn of a viral infection even before a person's immune system has kicked in. In other words, it's more sensitive to tests that only look for an immune system response to the hepatitis virus. That's the basis for this study.
Is Nucleic Acid Testing Feasible?
Pawlotsky's group wanted to find out if a form of testing known as nucleic acid testing could effectively detect hepatitis C or HIV RNA, and whether this technique should be used routinely to reduce the risk of transmitting viral infections to organ recipients during transplant procedures.
For their large study, they analyzed information on 2,236 organ donors, 636 tissue donors, and 177 cornea donors. The research team identified 5 HCV RNA-positive organ donors among a group of HCV-seronegative donors. There was also 1 HCV-seronegative tissue donor who tested positive for HCV RNA. Among donors who tested negative for antibodies to HIV, none tested positive for HIV RNA, Pawlotsky and his fellow investigators reported.
The findings suggest that routine nucleic acid testing might be feasible to detect viral infections more definitively than testing for antibodies to the infections, said Pawlotsky, who is also a professor of Medicine at the University of Paris XII.
"Implementation of systematic [nucleic acid testing] of tissue (and cell) donors is highly feasible because viral testing can be done every day, and can be based on standardized, partly automated, commercial techniques and procedures," Pawlotsky said. "Technical flaws currently hinder routine [nucleic acid testing] of organ donors, but not of tissue and cell donors," he explained. "Thus, [nucleic acid testing] techniques should be rapidly adapted to organ donor screening, and implementation should be discussed."
Liver transplantation is performed more often for people with cirrhosis than for any other reason, experts say. It's an option when other medical treatment cannot keep a damaged liver functioning properly.3 Last year, nearly 5,700 liver transplants were performed in the United States.4
1. Challine D, Pellegrin B, Bouvier-Alias M, Rigot P, Laperche L, Pawlotsky JM. HIV and hepatitis C virus RNA in seronegative organ and tissue donors. Lancet 2004 Oct 30;364(9445):1611-2.
2. Natov SN. Transmission of viral hepatitis by kidney transplantation: donor evaluation and transplant policies (Part 1: hepatitis B virus). Transpl Infect Dis 2002 Sep;4(3):124-31.
3. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health (NIH).
4. The Organ Procurement and Transplantation Network (OPTN). United Network for Organ Sharing (UNOS).
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
