Peter Boan

Background: Systems for quality and safety assurance in organ donation and transplantation are vital, especially those that seek to minimize donor disease transmission. Australia has developed a national vigilance and surveillance system to identify, review, and analyze actual and potential donor‐derived infections and other disease transmissions.Methods: The system involves notification of incidents to the Australian Organ and Tissue Authority for review by a Vigilance and Surveillance Expert Advisory Committee (VSEAC). The VSEAC grades incidents, O makes recommendations, and issues communications both publicly and to the clinical donation and transplant sector.Results: Annual notifications have increased since the inception of the system in 2012 until 2022. The vast majority relate to procedural aspects including donor assessment, information/data issues, and the recovery, offer, allocation, preservation and transportation of organs. Possible donor‐derived disease accounted for 19% of all notifications, and those related to possible donor‐derived infection only 12%. The VSEAC, as a result of reviewing these incidents, has made recommendations resulting in revisions to donor screening, organ allocation, packaging and transportation. The review of incidents has led to changes in clinical guidance for increased viral risk donor assessment, testing, and ensuing organ utilization and recipient surveillance. Guidance has also been reviewed for other infectious risks including strongyloides, human T‐lymphotropic virus, and HEV.Conclusion: The Australian vigilance and surveillance system has enabled national retrospective reporting and evaluation of serious adverse events or reactions to identify trends and inform processes and guidelines, therefore improving the safety of donation and transplantation. image

Coronavirus‐19 (COVID‐19) mortality rates among haemopoietic stem cell transplant (HSCT) patients are high, ranging between 20% and 40%. We prospectively evaluated the mortality outcomes of COVID‐19 in Western Australian HSCT patients. A total of 32/492 (6.5%) HSCT recipients contracted COVID‐19 during the study, of whom 30/32 (94%) developed mild or asymptomatic disease. Two allogeneic HSCT patients were hospitalised for severe COVID‐19; one patient died. Stringent healthcare, social isolation practices, aggressive vaccination programmes and rapid access to COVID‐19 antivirals may have promoted mild COVID‐19 illness in Western Australian HSCT patients, resulting in one of the lowest COVID‐19 mortality rates in HSCT recipients worldwide.

We transplanted six solid organs from three hepatitis C virus (HCV) polymerase chain reaction (PCR)‐positive donors during 2018–2023. Recipients were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 4–12 weeks, with all six achieving sustained virological response without significant adverse events. As occurs in other jurisdictions, solid organ transplants from HCR PCR‐positive donors can be safely utilised in Australia.

Background: Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID‐19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set.Aim: To examine the impact of COVID‐19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022.Participants: A total of 257 adults were admitted with COVID‐19 under either respiratory or the intensive care unit (ICU).Outcomes: Admission numbers, disease severity, ICU admission, prevalence of COVID‐19 deterioration risk factors, length of stay and mortality.Results: A total of 257 patients were admitted with COVID‐19, under respiratory (81.7%) and ICU (18.3%). COVID‐19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID‐19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases.Conclusion: The number of hospitalisations and ICU COVID‐19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID‐19 severity were incomplete immunisation and ATSI ethnicity.

Background: Cytomegalovirus (CMV) is a common cause of morbidity after allogeneic haematopoietic cell transplantation (alloHCT). Pre‐emptive therapy (PET) with valganciclovir (VGC) is associated with haematological toxicity.Methods: We included alloHCT patients from 2018 to 2021 where letermovir (LTV) was used for CMV PET because of cytopenias.Results: Ten patients were included. Six received VGC prior to LTV. VGC was commenced at median d42, given for median 40 days. LTV was commenced at median d90, given for median 54 days. At commencement of antiviral, CMV viral load was higher for VGC at 3.7 log₁₀ IU/mL, compared to LTV at 2.9 log₁₀ IU/mL. Viral load reduction occurred at 0.18 log₁₀ IU/mL per week for VGC, compared to 0.17 log₁₀ IU/mL per week for LTV. There was no clinically significant CMV viremia after stopping LTV. Cytopenias improved on LTV.Conclusion: LTV was effective in controlling CMV viremia when it was given at a lower starting CMV viral load and later post alloHCT than VGC. Further study is required of LTV as upfront PET following alloHCT. image