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Variant Creutzfeldt-Jakob disease: A cause for concern. Review of the evidence for risk of transmission through abdominal lymphoreticular tissue surgery

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Abstract

Background:

Concern has long existed regarding the possible iatrogenic spread of variant Creutzfeldt-Jakob disease (v-CJD) through surgery. This had been fueled by recent reports of bovine spongiform encephalopathy in U.S. cattle and the first probable case of blood transmission of v-CJD in the UK.

Methods:

Systematic review of experimental and nonexperimental studies. Studies identified from searches of Medline, Embase, Cochrane Library, Science Citation Index medical databases, searching bibliographies of retrieved papers, and personal communication with international experts in the field.

Results:

Six articles satisfied our search criteria. Evidence stems from case reports, case series, and cross-sectional studies. There are no published cases of surgically transmitted v-CJD.

Conclusion:

We found evidence of v-CJD prion agents in the spleen, appendix, rectum, and adrenal glands of affected patients and evidence of v-CJD prion in the appendix of patients in the preclinical stage of the disease. The risk of transmission of v-CJD prion during abdominal surgery is currently unquantifiable.

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Acknowledgments

Dr Aziz Sheikh is supported by a NHS R&D National Primary Care Fellowship. Tyco Healthcare funded this review. Miss Sisse Bjorn Olsen was the lead reviewer for this project and is the study’s guarantor. Miss Olsen wrote the study protocol, ran the searches, assessed study quality, extracted data, and took lead responsibility for drafting the paper. Dr. Aziz Sheikh supervised the day-to-day running of this review, contributing to protocol development, interpretation of results, and writing of the paper. Dr. David Peck co-reviewed papers, extracted data, and contributed to the writing of reports. Professor Ara Darzi was the overall supervisor for this project and contributed to the interpretation of results and the editing of the final manuscript.

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Authors and Affiliations

  1. Department of Surgical Technology and Oncology, Imperial College of Science, Technology and Medicine, St. Mary’s Hospital, London W2 1NY, United Kingdom

    S. B. Olsen, D. Peck & A. Darzi

  2. Division of Community Health Sciences: GP Section, University of Edinburgh, Levison House, 20 West Richmond Street , Edinburgh EH8 9DX, United Kingdom

    A. Sheikh

Authors
  1. S. B. Olsen
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  2. A. Sheikh
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  3. D. Peck
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  4. A. Darzi
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Corresponding author

Correspondence to S. B. Olsen.

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Olsen, S.B., Sheikh, A., Peck, D. et al. Variant Creutzfeldt-Jakob disease: A cause for concern. Review of the evidence for risk of transmission through abdominal lymphoreticular tissue surgery. Surg Endosc 19, 747–750 (2005). https://doi.org/10.1007/s00464-004-9205-2

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  • DOI: https://doi.org/10.1007/s00464-004-9205-2

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