ABSTRACT
Traditionally, when antibody to the Hepatitis B core antigen (anti-HBc) and antibody to the Hepatitis B surface antigen (anti-HBs) are positive, the donor is considered suitable. However, the literature contains cases with this profile and circulating hepatitis B virus DNA. The aim of the study is to analyze the incidence of occult hepatitis B virus infection (OBI). Retrospective data were evaluated for deceased tissue donors in ten Tissue Establishments (Spain) during 2017. The data included demographic data and the serological markers for hepatitis B that each tissue establishment performed. A total number of 1933 tissue donors were evaluated. A total of 180 donors were excluded: 6 (0.3%) with Hepatitis B surface antigen (HBs positive), and 174 in which DNA testing was not performed. Anti-HBc was positive in 175 donors (10%), in which anti-HBs was negative in 30 (17.1%) and positive in 145 (82.9%). In total, 27 donors with DNA positive (1.5%) were found, of which 3 of 117 donors (1.7%) showed anti-HBc negative and anti-HBs positive (> 10 IU/ml), 4 of 30 donors (13.3%) showed anti-HBc positive and anti-HBs negative and 20 of 145 donors (13.8%) showed both anti-HBc and anti-HBs positive. The highest probability of finding DNA occurs when anti-HBc is positive, regardless of the presence of anti-HBs. In our study, the probability of OBI was 1.5%. The classic concept that when anti-HBc and anti-HBs are positive (even with a titer of over 100 IU/ml) the donor can be accepted should, therefore, be reconsidered, and DNA testing should be mandatory.
Subject(s)
DNA, Viral/analysis , Donor Selection , Hepatitis B Antibodies/analysis , Hepatitis B virus/isolation & purification , Hepatitis B/diagnosis , Aged , DNA, Viral/genetics , Hepatitis B/epidemiology , Hepatitis B/immunology , Hepatitis B/virology , Hepatitis B Antibodies/immunology , Hepatitis B Core Antigens/immunology , Hepatitis B Surface Antigens/immunology , Hepatitis B virus/genetics , Hepatitis B virus/immunology , Humans , Middle Aged , Occult Blood , Retrospective Studies , Spain/epidemiology , Tissue DonorsSubject(s)
Enterovirus Infections/epidemiology , Meningitis, Viral/epidemiology , Meningoencephalitis/epidemiology , Age of Onset , Diagnosis, Differential , Enterovirus/isolation & purification , Enterovirus Infections/blood , Enterovirus Infections/cerebrospinal fluid , Enterovirus Infections/virology , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/blood , Infant, Premature, Diseases/cerebrospinal fluid , Infant, Premature, Diseases/epidemiology , Infant, Premature, Diseases/virology , Male , Meningitis, Bacterial/diagnosis , Meningitis, Viral/blood , Meningitis, Viral/cerebrospinal fluid , Meningitis, Viral/virology , Meningoencephalitis/blood , Meningoencephalitis/cerebrospinal fluid , Meningoencephalitis/virology , Nasopharynx/virology , Real-Time Polymerase Chain Reaction , Spain/epidemiology , Unnecessary ProceduresABSTRACT
INTRODUCTION AND OBJECTIVES: To assess the risk factors of cytomegalovirus (CMV) infection after heart transplant (HT) and its influence on long-term prognosis. METHODS: We conducted a retrospective single-centre study of 222 HT recipients. Risk factors for CMV infection were identified by means of multivariable CoxÌs regression. Kaplan-Meier analysis and CoxÌs regression were used to assess the long-term prognostic impact of CMV infection during the first post-transplant year. RESULTS: Donor-recipient CMV serologic matching (hazard ratio [HR] 1.92, 95% confidence interval [95% CI] 1.2-3.09, p=.007), recipient age (HR 1.02, 95% CI: 1.00-1.1, p=.02), diabetes mellitus (HR 1.86, 95% CI: 1.4-3.05, p=.01), pre-transplant circulatory support (HR 1.59, 95% CI: 1.06-2.38, p=.03) and the use of tacrolimus (HR 1.64, 95% CI: 1.13-2.36, p=.009) were independently associated with increased risk of CMV infection. CMV infection during the first year post-HT was not associated with worse transplant outcomes in terms of mortality, incidence of heart failure, cardiac allograft vasculopathy or acute rejection. CONCLUSIONS: CMV infection was not associated with impaired long-term prognosis after HT.