Risk of virus transmission through femoral head allografts: A Belgian appraisal.

Abstract

To evaluate the incidence and the risk of transmitting a virus through a bone allograft from a living donor. A total 7032 femoral heads have been collected from 24 Belgian institutions. The tissue along with the screening blood tests were systematically sent to the bank. Serological screening included: for HIV, a HIV1-2 antibody test; for HBV, a HBS antigen and HBS and Hbcore antibodies; for HCV, a HCV antibody test. Syphilis was also screened with a non-specific and a specific assays. HTLV1-2 screening was recommended but not obligatory. From the 7032 femoral heads, 1066 (15.2%) implants were definitively excluded. Hundred forty-six femoral heads, representing 2.1% of all grafts and 13.9% of the excluded ones, were discarded for positive serological testing associated with a risk of disease transmission. There were 2 donors who tested positive for HTLV1-2. The prevalence of HIV in the femoral head donor population was six times lower than in the general one. The prevalence of hepatitis B and C was similar but far higher than HIV. The risk was computed to be 0.54 out of 1 × 10(5) for HIV and HCV without quarantine or tissue processing. For HBV, the risk was 0.77 out of 1 × 10(5). Current standards of tissue banking incorporated safety and quality as their main features. This policy is now regulated at the European level. With a multi-step screening-policy, stringent donor selection guidelines, the risk of viral transmission trough a tissue is minimized.