Transmission of Hepatitis A Virus through Combined Liver-Small Intestine-Pancreas Transplantation

Abstract

Although transmission of hepatitis A virus (HAV) through blood transfusion has been documented, transmission through organ transplantation has not been reported. In August 2015, state health officials in Texas, USA, were notified of 2 home health nurses with HAV infection whose only common exposure was a child who had undergone multi-visceral organ transplantation 9 months earlier. Specimens from the nurses, organ donor, and all organ recipients were tested and medical records reviewed to determine a possible infection source. Identical HAV RNA sequences were detected from the serum of both nurses and the organ donor, as well as from the multi-visceral organ recipient's serum and feces; this recipient's posttransplant liver and intestine biopsy specimens also had detectable virus. The other organ recipients tested negative for HAV RNA. Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers.

Keywords: healthcare workers; hepatitis A virus; liver; pancrease; small intestine; transmission; transplantation; viremia; viruses.

Figure 1

Polygenetic analysis of HAV isolates within the Centers for Disease Control and Prevention’s US HAV database. The genomic regions are the 315-bp long HAV VP1/P2B (viral protein 1/amino terminus of 2B). Black squares indicate isolates from the outbreak of HAV transmitted through a combined liver–small intestine–pancreas transplantation, Texas, USA, 2014–2015. Scale bar indicates nucleotide variation. HAV, hepatitis A virus.

Figure 2

Clinical timeline of HAV infection among a multi–visceral organ transplantation recipient and infected healthcare workers, Texas, 2014–2015. ALT, alanine aminotransferase; HAV, hepatitis A virus.