Donor-derived Transmission of Hepatitis A Virus Following Kidney Transplantation: Clinical Course of Two Cases From One Donor

Jefferson M. Jones, MD; Avinash Agarwal, MD; Anne C. Moorman, MPH; Megan G. Hofmeister, MD; John C. Hulse, MD; Max O. Meneveau, MD; Tonya Mixon-Hayden, PhD; Sumathi Ramachandran, PhD; Christopher M. Jones, MD; Stephanie Kellner, MPH; Daniel Ferrell, MPH; Costi D. Sifri, MD

doi:10.1097/TXD.0000000000001506

Transplantation Direct (Aug 2023)

Donor-derived Transmission of Hepatitis A Virus Following Kidney Transplantation: Clinical Course of Two Cases From One Donor

Jefferson M. Jones, MD,
Avinash Agarwal, MD,
Anne C. Moorman, MPH,
Megan G. Hofmeister, MD,
John C. Hulse, MD,
Max O. Meneveau, MD,
Tonya Mixon-Hayden, PhD,
Sumathi Ramachandran, PhD,
Christopher M. Jones, MD,
Stephanie Kellner, MPH,
Daniel Ferrell, MPH,
Costi D. Sifri, MD

Affiliations

Jefferson M. Jones, MD: 1 Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Avinash Agarwal, MD: 2 Division of Transplantation, Department of Surgery, UVA Health, Charlottesville, VA.
Anne C. Moorman, MPH: 3 Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Megan G. Hofmeister, MD: 3 Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
John C. Hulse, MD: 4 University of Virginia School of Medicine, Charlottesville, VA.
Max O. Meneveau, MD: 5 Department of Surgery, UVA Health, Charlottesville, VA.
Tonya Mixon-Hayden, PhD: 3 Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Sumathi Ramachandran, PhD: 3 Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Christopher M. Jones, MD: 6 Division of Hepatobiliary and Transplant Surgery, Trager Transplant Center, University of Louisville, Louisville, KY.
Stephanie Kellner, MPH: 7 Central Shenandoah Health District, Virginia Department of Health, Richmond, VA.
Daniel Ferrell, MPH: 8 Rappahannock-Rapidan Health District, Virginia Department of Health, Richmond, VA.
Costi D. Sifri, MD: 9 Division of Infectious Diseases and International Health, Department of Medicine, UVA Health, Charlottesville, VA.

DOI: https://doi.org/10.1097/TXD.0000000000001506
Journal volume & issue: Vol. 9, no. 8
p. e1506

Abstract

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Background. Donor-derived transmission of infections is a rare complication of kidney transplant. Hepatitis A virus (HAV) is a common cause of acute viral hepatitis worldwide, but donor-derived transmission to organ recipients has been reported in the literature only twice previously. The timeline for HAV incubation and clearance in transplant recipients is not well understood. Methods. In 2018, 2 kidneys and a liver were procured from a deceased donor resident of Kentucky, one of many states that was experiencing an HAV outbreak associated with person-to-person transmission through close contact, primarily among people who reported drug use. Both kidney recipients, residents of Virginia, subsequently developed acute HAV infections. We report the results of an investigation to determine the source of transmission and describe the clinical course of HAV infection in the infected kidney recipients. Results. The liver recipient had evidence of immunity to HAV and did not become infected. The donor and both kidney recipients were found to have a genetically identical strain of HAV using a next-generation sequencing-based cyber molecular assay (Global Hepatitis Outbreak Surveillance Technology), confirming donor-derived HAV infections in kidney recipients. At least 1 kidney recipient experienced delayed development of detectable hepatitis A anti-IgM antibodies. By 383 and 198 d posttransplant, HAV RNA was no longer detectable in stool specimens from the left and right kidney recipients, respectively. Conclusions. Adherence to current guidance for hepatitis A vaccination may prevent future morbidity due to HAV among organ recipients. http://links.lww.com/TXD/A548

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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