Title: Recent, Five-Year HCV Sero-prevalence Trend Among Deceased Organ Donors in California
1Recent, Five-Year HCV Sero-prevalence Trend
Among Deceased Organ Donors in California
- Marek Nowicki1, Dem Brucal1, Claudia Chinchila1,
Steven Takemoto1, Wayne Babcock2, Helen Nelson4,
Tom Mone3, Robert Mendez1 - 1National Institute of Transplantation,
- 2California Transplant Donor Network,
- 3OneLegacy,
- 4Golden State Donor Service
2Estimated Incidence of Acute HCV Infection,
United States,1960-2001
Decline in injection drug users
Decline in transfusion recipients
Source Hepatology 200031777-82 Hepatology
19972662S-65S CDC, unpublished data
3Prevalence of HCV Infection by Age and Gender,
United States
Males
Total
Females
4The impact of HCV (US)
2000 2010 2020 2030 2040
HCV (Millions) 2.94 2.87 2.68 2.43 2.18
Cirrhosis (thousands) 472 721 859 880 828
Decomp C (thousands) 65 103 135 146 143
HCC (thousands) 7 11 13 13 12
Deaths (thousands) 13 28 36 40 39
(Davis, LT 2003)
5Background
- After successful introduction of screening for
antibodies to the hepatitis C virus (HCV) in
early 90s, and more recently, also for HCV RNA,
several authors reported a dramatic decrease of
new acute HCV infections in the US (Hepatology
200031777-82 Hepatology 19972662S-65S CDC) - Others published predictions of HCV epidemic
trajectories, showing steady decline of the
number of infected individuals in the next 30
years (Davis, LT, 2003) - Since 02 our laboratory has been evaluating HCV
serostatus of approx 850 cadaveric organ
donors/year. Recently (05) our testing algorithm
was supplemented by the sensitive TMA-based NAT
assay detecting HCV RNA.
6First results
7Aim
- To evaluate longitudinal trends in HCV prevalence
among cadaveric organ donors from southern and
northern California.
8Specific Questions
- Is there a significant change or decrease in HCV
sero-prevalence among transplant donors? - What factors are associated with HCV positivity?
9Material and Methods
- We tested 4,032 consecutive donors from 3 CA OPOs
(2 from N. Cal and 1 from S. Cal) - Testing period 2002-2007
- EIA (Ortho), confirmed with RIBA (Chiron)
- After 2005 HCV RNA NAT (Procleix, Chiron)
- Statistical Methods
- Chi-square and logistic regression
10HCV Donors in 3 CA OPOs
Year
PNS
PNS
P0.01
- Increase in OPO1, trend not significant in OPO 2
3
11HCV Donors by Donor Age
Plt0.001 for both OPOs
- gt80 HCV donors were between age 41-60
12HCV Donors with other Serology
Plt0.001
P0.001
Plt0.001
P0.048
P0.012
N21
N218
N467
N1169
N3319
13Factors Associated with HCV
Factor Reference Odds Ratio, 95 CI P
2004-05 2002-03 1.61, 0.97-2.69 0.065
2006-07 2.03, 1.26-3.30 0.004
Age 41-60 lt40 or gt60 1.77, 1.20-2.61 0.004
HBcAb HBcAb- 9.06, 6.17-13.3 lt0.001
- Prevalence of HCV increased
- HCV is almost twice as likely in 41-60 age group
- 9 times more likely when HBcAb positive
14Conclusions
- Our data suggest a significant variability from
year-to-year of HCV seroprevalance. - There seems to be significant differences of HCV
rates among OPOs in California. - Contrary to US-wide trends in HCVs sero-incident
rates, we observed no decrease of HCV
sero-prevalence among cadaveric donors in
California over past 5 years. - Our results suggest that due to still high
numbers of HCV cadaveric donors HCV NAT
screening is highly desirable to prevent the HCV
window donations and possible transmissions.
15Take home Message
- HCV rates differ among CA OPOs
- Rates were highest for age 41-60
- Rates overall increased in 2006-2007
- Change in targeted donor population?
- More stringent testing (NAT)?
- Increased use of non-optimal donors?
- Further studies are needed to examine factors
associated with outcomes for HCV donors
16Acknowledgments
- This presentation will not be possible without
- California Transplant Donor Network
- Donors and their families
- Golden State Donor Service
- National Institute of Transplantation
- OneLegacy
17(No Transcript)
18Prevalence of antibody to hepatitis C virus among
populations of US military Personnel
(Hyamas et al, A. J. f Epidemiology, 2001)