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21 May 2009

Possible errors in hbv and hcv testing due to fluid disorders in deceased organ donors

J Czerwiński, A Pszenny, M Łaba, K Ostrowski, M Pacholczyk, D Wasiak, M Kosieradzki, A Chmura, P Małkowski

Ann Transplant 2009; 14(1): 21-21 :: ID: 880274

Abstract

Background: To avoid viral transmission from the donor to recipient, several serological tests are obligatory (anti-HIV, anti-HCV, HBsAg) or strongly recommended (anti-HBc, anti-CMV) in the donor. There are some limitations of viral determination methods even when using new generations of ELISA-tests: detection limit is difficult to define, genotypes and different preparations of sample react differently. On the other hand the process of donor management is associated with alterations and disturbances in fluid and electrolyte balance which, we suggest, may potentially influence viral testing to provide a percentage of false-negative or false-positive results. In order to explore the potentiality of erroneous determination of hepatitis B and C markers in cadaveric donors we designed a study of over 2000 donors with the following aims: - to assess and compare the incidence of positive/negative anti-HCV, HBsAg and anti-HBc results tested in the group of donors with low, normal or elevated hematocrite - to assess and compare the incidence of positive/negative anti-HCV, HBsAg and anti-HBc results tested in the group of donors with low-, normal or elevated osmolality .
Material/Methods: Between 2004 and 2007, 2435 possible deceased donors
were referred to Poltransplant. 1967 of them were effective. Anti-HCV antibodies were tested in 2185 and HBsAg in 2200 referred donors (including all effective cases). Anti-HBc was evaluated in 1183 referred donors, including 1087 in effective donors. In all studied donors the values of hematocrite (l/l) were recorded and osmolality (miliosmoles/kg) was calculated: P.OSM=2[NA] 2[K] [Urea] [Glucose]. Donors were stratified into groups with low (0.11-0.36), normal (0.36-0.44) and elevated (0.45-0.56) hematocrite and into groups with hypoosmolality (256-279), normal (280-300) and with hyperosmolality (301-404). A correlation between incidences of positive/negative results of viral markers was performed. Chi-test was used for statistical analysis, p-value of <0.05 were considered statistically significant.
Results: Among donors 61 (2.8%) tested anti-HCV(). In the group of donors with hematocrite 0.11 to 0.35 we observed a significantly lower incidence (2.2%, p=0.04) of negative tests. In the group with hypoosmolarity visibly higher percentage of positive tests were recorded (6.9%), but not significantly. HBsAg tests were positive in 15 cases (0.7%). Although in the group of donors with elevated hematocrite, hypo- and normal osmolality the numbers of HBsAg() were distinctly very low (0 or 1), it was not possible estimate the signifi cance due to small groups.

Keywords: Deceased Donor, viral infections

Comments

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358