Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from liv
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Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors Thomas Kappe Æ Balkan Cakir Æ Thomas Mattes Æ Heiko Reichel Æ Markus Flo¨ren
Received: 19 August 2008 / Accepted: 14 June 2009 / Published online: 27 June 2009 Ó Springer Science+Business Media B.V. 2009
Abstract In the advent of the EU guidelines 2004/ 23/EG and 2006/17/EG requiring extensive safety and quality steps in bone banking, the prevalence and risk of infection disease transmission from bone allograft needs to be reconsidered. Therefore, we prospectively reviewed the screening process of bone donations and the outcome of surgeries utilizing bone allografts from our internal hospital bone bank with regard to infections according to CDC criteria. Onehundred and eighty-eight allogenic bone transplantation procedures in 160 patients were followed-up for 12–64 months (mean 32 months). Bacterial infection occurred in 11 patients, the overall infection rate therefore was 6.9%. After review of the clinical and intraoperative findings, none of the infections were likely to have been caused by the bone graft. Although no follow-up serologic testing was performed, no HIV of hepatitis infections were observed. Frozen bone allografts derived from live donors and provided by hospitals can generally be considered safe. However, without new and relevant clinical expertise, continuing this technique will be impeded by the new EU guidelines and their national implementations.
T. Kappe B. Cakir T. Mattes H. Reichel M. Flo¨ren (&) University of Ulm, Ulm, Germany e-mail: [email protected]
Keywords Bone banking Allograft transplantation Infection transmission Allogenic bone
Introduction In Europe, and especially in Germany, the most widely distributed method of supplying allogenic bone grafts is internal hospital bone banks (Aho et al. 1998; Hart et al. 1986; Ivory and Thomas 1993; Meermans et al. 2007; Nather and David 2007; Schreurs et al. 2003; Sutherland et al. 1997). Femoral heads retrieved during primary hip arthroplasty procedures are usually stored in a fresh-frozen fashion. Many institutions do not perform additional preparation steps, such as gamma irradiation or heat (Pruss et al. 2003). Although the use of bone allografts has grown, optimal use has been restricted by availability and concerns for recipient safety (Tomford 2000). Common complications of allogenic bone transplantation include non-union (Mankin et al. 1996), viral disease transmission (CDC 1988; Conrad et al. 1995), and bacterial infection (Aho et al. 1998; Chapman and Villar 1992; Chiu et al. 2004; Deijkers et al. 1997, Hou et al. 2005; Liu et al. 2002; Mankin et al. 1983; Nather and David 2007; Sommerville et al. 2000; Sutherland et al. 1997; Tomford et al. 1981, 1990; Winter et al. 2005). Recently, the EU released guidelines 2004/23/EG and 2006/17/EG (EU 2004) which redefine the framework for human tissue transplantation including
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bone allograft transplantation. While these new direc
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