Condition
Any acupuncture, body piercing, permanent or semi-permanent make-up or tattoo.
Individual at risk
Recipient
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
ACCEPTABLE
Guidance at CT/WORK-UP
ACCEPTABLE at the discretion of the requesting transplant centre, who should be informed where and when the procedure occured.
Nucleic acid testing (NAT) for hepatitis B, C and HIV are recommended.
Justification for guidance
There is a risk of transmission of blood-borne viruses, particularly hepatitis B and C, through the use of inadequately sterilised equipment used for tattoo, acupuncture and body piercings. A 4 month deferral is recommended from the date of the procedure, but this may be reduced by the transplant centre if it is thought that the risk of acquiring an infectious disease is outweighed by the risk of delaying transplantation.
4 months allows for the 'window period' between disease exposure and the earliest the disease may be detected by modern nucleic acid testing (NAT) assays.
References
Silverman AL, Sekhon JS, Saginaw SJ, Wiedbrauk D, Balasubramaniam M, Gordon SC. Tattoo application is not associated with an increased risk for chronic viral hepatitis. Am J Gastroenterol 2000; 95(5): 1312-5.
Rosario Pac M, Arnedo A, Montaner MD, Prieto P, Garcia J, Izuel M et al. [Epidemic outbreak of hepatitis B from the tattoo in gypsy families]. Rev Esp Salud Publica 1996; 70(1): 63-9.
Davis AR. Tattoo parlours and hepatitis C virus infection. Med J Aust 1995; 163(10): 556-7.
Ernst E, Sherman KJ. Is acupuncture a risk factor for hepatitis? Systematic review of epidemiological studies. J Gastroenterol Hepatol 2003; 18(11): 1231-6.
Walsh B, Maguire H, Carrington D. Outbreak of hepatitis B in an acupuncture clinic. Commun Dis Public Health 1999; 2(2): 137-40.
Arya SC. Acupuncture in epidemic HBV hepatitis: other ritual surgical procedures in Africa as well. Hepatology 1989; 9(3): 511.
Kent GP, Brondum J, Keenlyside RA, LaFazia LM, Scott HD. A large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol 1988; 127(3): 591-8.
Stryker WS, Gunn RA, Francis DP. Outbreak of hepatitis B associated with acupuncture. J Fam Pract 1986; 22(2): 155-8.
Hayes MO, Harkness GA. Body piercing as a risk factor for viral hepatitis: an integrative research review. Am J Infect Control 2001; 29(4): 271-4.