H2>Clostridium musculoskeletal allograft infections are still a danger!
"Transplant surgery" used to mean kidneys and livers and hearts; however, today, these aren't the only body parts finding new homes.
Surgeons are using transplanted tendons and cartilage to rebuild damaged knees, and harvesting bone to shore up aching backs.
Two decades ago, these "musculoskeletal" transplants were rare. Now they're used on more than a million patients a year in the U.S. alone. What many recipients don't know is that these recycled bits of tendon or bone can sometimes make them sick.
Stolen body parts present serious problems
A business in New Jersey has been accused of selling body parts stolen from corpses at funeral homes. The case got a lot of attention, especially after it turned out that one of those plundered cadavers was the late Alistair Cooke of "Masterpiece Theatre".
- The stolen body parts hadn't gone through the usual safety checks, yet they ended up in hundreds of unsuspecting patients, who may have been exposed to a wide range of diseases.
- That is just one incident showing that transplanted body tissues aren't always safe.
- Dr. Lennox Archibald, Medical Director, Regeneration Technologies, says he investigated the case because he just happened to be on call that day at the Centers for Disease Control and Prevention in Atlanta, Georgia.
- His job was to investigate infections that occurred in hospitals or other health-care settings.
- He received a report about a transplant in Minnesota that went very wrong.
- "It was a young man," he says. "I think he was 23.
- He underwent a knee procedure and within two to three days, he developed symptoms: a fever, feeling unwell; and by the time he went to the emergency room, he had a high fever, and he died soon after.
- It turned out that the man apparently received cartilage that was contaminated with a nasty bacteria called clostridium.
- The infection occurred even though the tissue bank involved had apparently followed the rules.
- Archibald suspected there were other cases, but it was hard to know how many.
- At the time there was no surveillance system or reporting system for musculoskeletal allograft infections.
Archibald says it didn't take long before CDC investigators began to understand why these infections could occur.
Sterilization methods that do not adversely affect the functioning of transplanted tissue are needed to prevent allograft-related infections
Bones and tendons are usually the last things to be removed from a dead person who has agreed to donate body parts.
Organs; such as, kidneys and livers are usually taken first; and while that's going on, Archibald says, the corpse starts to decompose.
"Within hours, bugs that would ordinarily be eliminated, killed, start proliferating in the bloodstream," according to Archibald.
Those bugs may eventually reach tendons and bones and cartilage. Most tissue banks try to eliminate bacteria by soaking the tissues in antibiotics.
Such actions don't get rid of viruses or tough bacteria like clostridium.
There is a need to sterilize
Archibald published his findings in the New England Journal of Medicine in 2004. The article concluded that there was a great need to sterilize tissues before transplanting them.
He says the need is even more important today, partly because many surgeons already think the bones and tendons they're transplanting have been sterilized.
By the time the New England Journal article came out, Archibald had left the CDC to join the University of Florida. He also had decided he wanted to do something to make tissue transplants safer.
Archibald became the medical director of a company that had found a way to truly sterilize bones and tendons without damaging them. Since then, a second company has also found a way to safely sterilize tissue.
Doctors are just beginning to offer their patients sterilized transplants.
Dr. Alexander Sapega is an orthopedic surgeon in New Jersey. He says he had never been completely comfortable using cadaver tissues.
"For the past 15 years, we've always had a very nagging concern, both on our end as well as the patient's end, about the potential for disease transmission," he says.
Sapega said patients tend to worry about getting hepatitis or HIV; however, surgeons know that common bacteria can do a lot of damage even if they don't kill you.
"A simple bacterial infection that is not life-threatening is an extremely nasty thing to deal with in a knee," he says. "It can cause premature arthritis in the knee joint. The toxins emitted by certain types of bacteria can sort of eat away at the cartilage and essentially wreck a knee joint."
Most surgeons still don't offer sterilized transplants. Fewer than ten percent of eligible patients receive sterilized transplants.