Transmission of Neurodegenerative Disorders Through Blood Transfusion: A Cohort Study

Gustaf Edgren, Henrik Hjalgrim, Klaus Rostgaard, Paul Lambert, Agneta Wikman, Rut Norda, Kjell-Einar Titlestad, Christian Erikstrup, Henrik Ullum, Mads Melbye, Michael P Busch, Olof Nyrén

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: The aggregation of misfolded proteins in the brain occurs in several neurodegenerative disorders. Aberrant protein aggregation is inducible in rodents and primates by intracerebral inoculation. Possible transfusion transmission of neurodegenerative diseases has important public health implications.

OBJECTIVE: To investigate possible transfusion transmission of neurodegenerative disorders.

DESIGN: Retrospective cohort study.

SETTING: Nationwide registers of transfusions in Sweden and Denmark.

PARTICIPANTS: 1 465 845 patients who received transfusions between 1968 and 2012.

MEASUREMENTS: Multivariable Cox regression models were used to estimate hazard ratios for dementia of any type, Alzheimer disease, and Parkinson disease in patients receiving blood transfusions from donors who were later diagnosed with any of these diseases versus patients who received blood from healthy donors. Whether excess occurrence of neurodegenerative disease occurred among recipients of blood from a subset of donors was also investigated. As a positive control, transmission of chronic hepatitis before and after implementation of hepatitis C virus screening was assessed.

RESULTS: Among included patients, 2.9% received a transfusion from a donor diagnosed with one of the studied neurodegenerative diseases. No evidence of transmission of any of these diseases was found, regardless of approach. The hazard ratio for dementia in recipients of blood from donors with dementia versus recipients of blood from healthy donors was 1.04 (95% CI, 0.99 to 1.09). Corresponding estimates for Alzheimer disease and Parkinson disease were 0.99 (CI, 0.85 to 1.15) and 0.94 (CI, 0.78 to 1.14), respectively. Hepatitis transmission was detected before but not after implementation of hepatitis C virus screening.

LIMITATION: Observational study design, underascertainment of the outcome, and possible insufficient statistical power.

CONCLUSION: The data provide no evidence for the transmission of neurodegenerative diseases and suggest that if transmission does occur, it is rare.

PRIMARY FUNDING SOURCE: Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, and Danish Council for Independent Research.

OriginalsprogEngelsk
TidsskriftAnnals of Internal Medicine
Vol/bind165
Udgave nummer5
Sider (fra-til)316-324
ISSN0003-4819
DOI
StatusUdgivet - 2016

Fingeraftryk

Neurodegenerative Diseases
Cohort Studies
Hepacivirus
Parkinson Disease
Alzheimer Disease
Chronic Hepatitis
Denmark
Proportional Hazards Models
Research
Primates
Hepatitis
Biomedical Research
Rodentia
Proteins
Retrospective Studies
Public Health
Lung

Citer dette

Edgren, G., Hjalgrim, H., Rostgaard, K., Lambert, P., Wikman, A., Norda, R., ... Nyrén, O. (2016). Transmission of Neurodegenerative Disorders Through Blood Transfusion: A Cohort Study. Annals of Internal Medicine, 165(5), 316-324. https://doi.org/10.7326/M15-2421
Edgren, Gustaf ; Hjalgrim, Henrik ; Rostgaard, Klaus ; Lambert, Paul ; Wikman, Agneta ; Norda, Rut ; Titlestad, Kjell-Einar ; Erikstrup, Christian ; Ullum, Henrik ; Melbye, Mads ; Busch, Michael P ; Nyrén, Olof. / Transmission of Neurodegenerative Disorders Through Blood Transfusion : A Cohort Study. I: Annals of Internal Medicine. 2016 ; Bind 165, Nr. 5. s. 316-324.
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Edgren, G, Hjalgrim, H, Rostgaard, K, Lambert, P, Wikman, A, Norda, R, Titlestad, K-E, Erikstrup, C, Ullum, H, Melbye, M, Busch, MP & Nyrén, O 2016, 'Transmission of Neurodegenerative Disorders Through Blood Transfusion: A Cohort Study', Annals of Internal Medicine, bind 165, nr. 5, s. 316-324. https://doi.org/10.7326/M15-2421

Transmission of Neurodegenerative Disorders Through Blood Transfusion : A Cohort Study. / Edgren, Gustaf; Hjalgrim, Henrik; Rostgaard, Klaus; Lambert, Paul; Wikman, Agneta; Norda, Rut; Titlestad, Kjell-Einar; Erikstrup, Christian; Ullum, Henrik; Melbye, Mads; Busch, Michael P; Nyrén, Olof.

I: Annals of Internal Medicine, Bind 165, Nr. 5, 2016, s. 316-324.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Transmission of Neurodegenerative Disorders Through Blood Transfusion

T2 - A Cohort Study

AU - Edgren, Gustaf

AU - Hjalgrim, Henrik

AU - Rostgaard, Klaus

AU - Lambert, Paul

AU - Wikman, Agneta

AU - Norda, Rut

AU - Titlestad, Kjell-Einar

AU - Erikstrup, Christian

AU - Ullum, Henrik

AU - Melbye, Mads

AU - Busch, Michael P

AU - Nyrén, Olof

PY - 2016

Y1 - 2016

N2 - BACKGROUND: The aggregation of misfolded proteins in the brain occurs in several neurodegenerative disorders. Aberrant protein aggregation is inducible in rodents and primates by intracerebral inoculation. Possible transfusion transmission of neurodegenerative diseases has important public health implications.OBJECTIVE: To investigate possible transfusion transmission of neurodegenerative disorders.DESIGN: Retrospective cohort study.SETTING: Nationwide registers of transfusions in Sweden and Denmark.PARTICIPANTS: 1 465 845 patients who received transfusions between 1968 and 2012.MEASUREMENTS: Multivariable Cox regression models were used to estimate hazard ratios for dementia of any type, Alzheimer disease, and Parkinson disease in patients receiving blood transfusions from donors who were later diagnosed with any of these diseases versus patients who received blood from healthy donors. Whether excess occurrence of neurodegenerative disease occurred among recipients of blood from a subset of donors was also investigated. As a positive control, transmission of chronic hepatitis before and after implementation of hepatitis C virus screening was assessed.RESULTS: Among included patients, 2.9% received a transfusion from a donor diagnosed with one of the studied neurodegenerative diseases. No evidence of transmission of any of these diseases was found, regardless of approach. The hazard ratio for dementia in recipients of blood from donors with dementia versus recipients of blood from healthy donors was 1.04 (95% CI, 0.99 to 1.09). Corresponding estimates for Alzheimer disease and Parkinson disease were 0.99 (CI, 0.85 to 1.15) and 0.94 (CI, 0.78 to 1.14), respectively. Hepatitis transmission was detected before but not after implementation of hepatitis C virus screening.LIMITATION: Observational study design, underascertainment of the outcome, and possible insufficient statistical power.CONCLUSION: The data provide no evidence for the transmission of neurodegenerative diseases and suggest that if transmission does occur, it is rare.PRIMARY FUNDING SOURCE: Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, and Danish Council for Independent Research.

AB - BACKGROUND: The aggregation of misfolded proteins in the brain occurs in several neurodegenerative disorders. Aberrant protein aggregation is inducible in rodents and primates by intracerebral inoculation. Possible transfusion transmission of neurodegenerative diseases has important public health implications.OBJECTIVE: To investigate possible transfusion transmission of neurodegenerative disorders.DESIGN: Retrospective cohort study.SETTING: Nationwide registers of transfusions in Sweden and Denmark.PARTICIPANTS: 1 465 845 patients who received transfusions between 1968 and 2012.MEASUREMENTS: Multivariable Cox regression models were used to estimate hazard ratios for dementia of any type, Alzheimer disease, and Parkinson disease in patients receiving blood transfusions from donors who were later diagnosed with any of these diseases versus patients who received blood from healthy donors. Whether excess occurrence of neurodegenerative disease occurred among recipients of blood from a subset of donors was also investigated. As a positive control, transmission of chronic hepatitis before and after implementation of hepatitis C virus screening was assessed.RESULTS: Among included patients, 2.9% received a transfusion from a donor diagnosed with one of the studied neurodegenerative diseases. No evidence of transmission of any of these diseases was found, regardless of approach. The hazard ratio for dementia in recipients of blood from donors with dementia versus recipients of blood from healthy donors was 1.04 (95% CI, 0.99 to 1.09). Corresponding estimates for Alzheimer disease and Parkinson disease were 0.99 (CI, 0.85 to 1.15) and 0.94 (CI, 0.78 to 1.14), respectively. Hepatitis transmission was detected before but not after implementation of hepatitis C virus screening.LIMITATION: Observational study design, underascertainment of the outcome, and possible insufficient statistical power.CONCLUSION: The data provide no evidence for the transmission of neurodegenerative diseases and suggest that if transmission does occur, it is rare.PRIMARY FUNDING SOURCE: Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, and Danish Council for Independent Research.

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U2 - 10.7326/M15-2421

DO - 10.7326/M15-2421

M3 - Journal article

C2 - 27368068

VL - 165

SP - 316

EP - 324

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 5

ER -

Edgren G, Hjalgrim H, Rostgaard K, Lambert P, Wikman A, Norda R et al. Transmission of Neurodegenerative Disorders Through Blood Transfusion: A Cohort Study. Annals of Internal Medicine. 2016;165(5):316-324. https://doi.org/10.7326/M15-2421