Hong Kong public hospitals to consider new test for hepatitis E virus in organ donors after five transplant patients infected
Case is the first of its kind from one donor, sparking screening concerns, with experts to discuss treatment and future procedures
Public hospitals in Hong Kong will consider introducing a new test for a virus in organ donors after five patients in transplants were infected with liver disease.
The patients, aged six to 66, were found to be infected with hepatitis E after they received new organs from a deceased donor, Queen Mary Hospital announced on Monday. This was the first time in the world as many as five organ recipients had contracted the disease in a single case.
The infections were revealed after two men, aged 59 and 66, suffered from abnormal liver functions in early July and August and were both diagnosed with the disease.
Both men had undergone transplants in February. Investigators contacted three other patients who had received organs from the same donor.
One of the five patients had died, but Professor Yuen Kwok-yung from the University of Hong Kong’s microbiology department said he believed the death was unlikely to be caused by hepatitis E.
The patient received a bilateral lung transplant on February 28 but later suffered from post-operative pneumonia and pleural effusion, a build-up of fluid in the chest area. He was treated at Grantham Hospital. He later died on August 18, with traces of the zoster encephalitis virus – a different disease – and related antigens found in his blood and skin.
Referring to the hepatitis E infection in all five patients, Yuen said on Tuesday: “The university team believes that the infection channel is the donated organs.
“The virus can be transmitted to humans from animals such as pigs and deer.”
Yuen said this was not the only case of hepatitis E infection from an organ donation. He cited a case of two patients infected with the virus after receiving kidneys from a donor. But this was the first time as many as five patients had been infected, he added.
In terms of treatment, he said Ribavirin, an antiviral medication, is considered to be effective for hepatitis E. It is expected to have a success rate of about 80 per cent.
According to Yuen, from last Friday to Monday, all four patients were put on Ribavirin treatment.
“But it still depends on the genome of each patient to see if the treatment is really useful,” Yuen said.
He also said there was currently no requirement to test organ donors for the virus because it was rare and a blood test might not be comprehensive enough.
Dr Luk Che-chung, the chief executive of the Hong Kong West hospital cluster, said an expert group would discuss a solution, including whether it was necessary to introduce a test. The group would also explore whether infected organs would still be suitable for transplants and what treatment should follow.
According to Yuen, Britain is the only country that conducts tests for the virus. There is no such requirement in the United States or Australia.
“The Netherlands used to do the test, but it stopped because there were too few cases,” Yuen said. “In Hong Kong, it’s probably one in thousands.”
He also stressed that, as suitable organs for transplants were hard to come by, it was worth discussing if organs infected with hepatitis E could still be used in transplants, provided patients get early treatment.
“It will be left to the experts to debate and measure the advantages and disadvantages,” Yuen said.
In 2012, Hong Kong saw the highest number of such infections, with 120 cases. According to Yuen, the amount of cases annually since then numbered in the dozens.
The Hospital Authority and the Centre for Health Protection are aware of the case, and are in contact with the affected patients to provide help and treatment.
Yuen said there was also a vaccine against the hepatitis E virus that could offer up to 90 per cent protection. But he said he doubted if the method worked in the case of organ transplants because anti-rejection drugs administered to recipients would weaken their immune systems and counter the effectiveness of the vaccines.