NR ACKO
AU Cavanagh,H.D.; Hogan,R.N.
TI Preventing prion transmission in corneal transplants
QU JAMA. Journal of the American Medical Association 1999 Dec 15; 282(23): 2211
IA http://jama.ama-assn.org/issues/v282n23/full/jlt1215-5.html
KZ JAMA. 1999 Jun 23-30;281(24):2330-9. PMID: 10386559
PT comment; letter
VT
Preventing Prion Transmission in Corneal Transplants
To the Editor: We agree with the Council on Scientific Affairs' recommendation that "physicians become knowledgeable about BSE [bovine spongiform encephalopathy] so they can appropriately advise their patients about routes and rates of BSE transmission."[1] Unfortunately, there is only passing mention of prion transmission by corneal transplantation, which is performed on 40,000 to 50,000 patients each year in the United States.[2] In addition to the 1974 US case,[3] 2 additional cases of probable and possible transmission, respectively, have been reported in Germany and Japan,[3] but the major new concern relative to prion transmission via corneas occurred recently in Great Britain. In February 1997, the corneal transplant and sclera from a 53-year-old woman who had died of presumed metastatic lung cancer were transplanted to 3 recipients.[4] In November 1997, the donor's brain revealed sporadic Creutzfeldt-Jakob disease (CJD), confirmed by the United Kingdom CJD Surveillance Unit.[4] Although transplanted tissues were subsequently removed, these 3 cases raise particular concern since infectivity of ocular tissue in scrapie was reported as 5.4 log U/mL median infective dose (cornea) compared with 8.9 log U/mL (brain) and 8.5 log U/mL (retina).[3]
The demonstrated possibility of further CJD or potential new variant-CJD (nv-CJD) corneal transmission has created heightened medical and public scrutiny of US eye donor screening standards; recently tightened criteria were approved by the Eye Bank Association of America.[5] Fortunately, no additional corneal transmission has been reported in the United States since 1974, and additional safeguards in place should further ensure the highest standards of continued tissue safety in this country.
H. Dwight Cavanagh, MD, PhD R. Nick Hogan, MD, PhD University of Texas Southwestern Medical Center at Dallas
1. Tan T, Williams MA, Khan MK, et al. Risk of transmission of spongiform encephalopathy to humans in the United States: report of the Council on Scientific Affairs. JAMA. 1999;281:2330-2339.
2. Eye Bank Association of America. Eye banking statistical report. Washington, DC: Eye Bank Association of America; 1997.
3. Hogan RN, Brown P, Heck E, Cavanagh HD. Risk of prion disease transmission from ocular tissue transplantation. Cornea. 1999;18:2-11.
4. Royal College of Ophthalmologists. CJD and the Eye. London, England: Royal College of Ophthalmologists; 1998. Monograph 7.
5. http://www.fda.gov/cber/rules/suitdonor.txt. Accessed November 29, 1999.
In Reply: The transmission of classic CJD via corneal transplantation has been demonstrated, and the potential possibility of transmission of nv-CJD via corneal transplantation should be taken into consideration. With ongoing national efforts to increase organ and tissue donation, we are pleased to hear from Drs Cavanagh and Hogan that the additional safeguards introduced in the new eye donor screening standards and recently approved by the Eye Bank Association of America will ensure the highest standards of safety in this tissue.
Litjen Tan, PhD Michael A. Williams, MD Council on Scientific Affairs American Medical Association Chicago, Ill
(c) 1999 American Medical Association. All rights reserved.
IN In den USA werden jährlich 40.000-50.000 Hornhautübertragungen durchgeführt. Dennoch wurden seit dem ersten Fall von Creutzfeldt-Jakob-Krankheit bei einer Empfängerin von Augenhornhaut eines anderen Creutzfeldt-Jakob-Patienten im Jahre 1974 keine derartigen Fälle in den USA gemeldet.
ZR 4
MH *Corneal Transplantation; *Eye Banks; Human; Prion Diseases/*transmission
SP englisch
PO USA