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estimated using random effects. c Serological window period assumed in the calculation of residual risk estimates based on serological screening (EIA) alone: HIV=22 days, HCV=70 days, HBV=44 days14 d Eclipse period for NAT testing assumed in the calculation of residual risk estimates based on EIA + NAT: HIV=7 days, HCV=5 days, HBV=22 days.14 e Upper risk estimate is derived from the upper 95% confidence limit of the risk estimate. f Data on the incidence of HBV in the Australian population are not available. It was therefore necessary to estimate the residual risk of undetected HBcAb and HBsAg separately. These estimates should be interpreted as the risk that, despite a negative test result, the donor is positive for either HBcAb (past, persistent or acute-phase infection) or HBsAg (active infection) respectively. General considerations when transplanting organs from increased-risk donors When the transplantation of solid organs is being considered from a donor identified as being at increased risk of HIV, HBV or HCV transmission, standard measures should be taken, including: • Donor NAT (prospective testing is strongly advised) • Discussion with a specialist with viral hepatitis and transplantation expertise (e.g. hepatologist or infectious diseases specialist) Risk Factor Incidenceb (95% Confidence Interval) per 100 person-years Residual infection risk Enzyme immunoassay (EIA) serologyc EIA serology +nucleic acid testing (NAT)d Risk estimate Upper risk estimatee Risk estimate Upper risk estimatee Human immunodeficiency virus Men who have sex with men 2,835 1 in 1,426 April 2021 version 1.5 16 • Consideration of recipient status—transplantation may be appropriate for recipients who are immune (for HBV), at risk of reactivation, with existing active infection, or where suitable treatments exist in the event of disease transmission (i.e. HCV) • Consideration of recipient urgency for transplant – the risk of transplanting organs from increased-risk donors may be more appropriate for patients in urgent need of a life-saving transplant • Specific informed consent must be obtained from the recipient prior to transplantation • Post transplant prophylaxis where applicable, in consultation with a hepatologist or infectious diseases specialist • Post transplant screening for acute infection (see below). Follow-up of recipients of organs from increased-risk donors For all recipients of organs from donors identified as being at increased risk of infection with HIV, HBV or HCV, post-transplant surveillance for the appearance of infection should occur. Given that serological testing may be unreliable in recipients or serological conversion may be delayed, HCV testing should be performed using NAT. Surveillance for appearance of HIV in recipients post-transplant should be performed using the HIV Ab/ Ag combination assay or HIV NAT; surveillance for HBV should be performed by testing for the appearance of HBsAg or by HBV NAT. The first follow-up test should ideally occur within 30 days of transplantation, and follow-up out to 12 months is recommended (with the frequency of repeat testing from months 2-11 at the discretion of the treating physician).