Transplant Trial Watch

Residual risk of infection with blood-borne viruses in potential organ donors at increased risk of infection: systematic review and meta-analysis.

Waller, K.M., et al.

Med J Aust. 2019;211(9):414-420


Aims
To summarise published prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among high risk groups in Australia. The authors also estimated the residual risk of each infection in potential donors from these groups who had a negative viral test.

Interventions
Not applicable

Participants
High risk groups which included injecting drug users, sex workers, men who have sex with men (MSM), people with a history of imprisonment, people with partners at high risk and people who have had percutaneous exposure to blood-borne virus-infected blood.

Outcomes
Residual risk of infection (the expected number of new infections currently in the window period, based on the calculated incidence rate)

Follow-up
Not applicable

CET Conclusions
The systematic review and meta-analysis summarised the published prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among high risk groups in Australia. In addition, the residual risk of these infections was estimated in potential donors in these groups with negative test results. Medline and grey literature was searched from 2000. Two independent authors screened full text publications for eligibility but it was unclear whether data extraction and critical appraisal were also done by two independent authors. The review included 75 studies and 89 risk group samples. Most of these 89 samples included injecting drug users (32 samples), men who have sex with men (28 samples), or prisoners (22 samples). Incidence and prevalence estimates were most frequently reported for HCV (54 estimates) and HIV (45 estimates). Risk of bias was judged to be low for 86% of assessed items, unclear for 11% of items and high for 6% of items. The residual risk of HIV infection was highest among men who have sex with men. The residual risk of HCV and HBV infection was highest among inject drug users. However, the absolute risks were considered low and the authors conclude that accepting organ donations by people at increased risk of infection but with negative viral test results could be a potential strategy for expanding the donor pool.

Quality notes
Not applicable

Trial registration
PROSPERO - CRD42017069820

Funding source
Non-industry funded