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Recent, Five-Year HCV Sero-prevalence Trend Among Deceased Organ Donors in California

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Recent, Five-Year HCV Sero-prevalence Trend Among Deceased Organ Donors in California Marek Nowicki1, Dem Brucal1, Claudia Chinchila1, Steven Takemoto1, Wayne ... – PowerPoint PPT presentation

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Title: Recent, Five-Year HCV Sero-prevalence Trend Among Deceased Organ Donors in California


1
Recent, 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

2
Estimated 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19972662S-65S CDC, unpublished data
3
Prevalence of HCV Infection by Age and Gender,
United States
Males
Total
Females
4
The 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)
5
Background
  • 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.

6
First results
7
Aim
  • To evaluate longitudinal trends in HCV prevalence
    among cadaveric organ donors from southern and
    northern California.

8
Specific Questions
  • Is there a significant change or decrease in HCV
    sero-prevalence among transplant donors?
  • What factors are associated with HCV positivity?

9
Material 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

10
HCV Donors in 3 CA OPOs
Year
PNS
PNS
P0.01
  • Increase in OPO1, trend not significant in OPO 2
    3

11
HCV Donors by Donor Age
Plt0.001 for both OPOs
  • gt80 HCV donors were between age 41-60

12
HCV Donors with other Serology
Plt0.001
P0.001
Plt0.001
P0.048
P0.012
N21
N218
N467
N1169
N3319
13
Factors 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

14
Conclusions
  • 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.

15
Take 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

16
Acknowledgments
  • 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)
18
Prevalence of antibody to hepatitis C virus among
populations of US military Personnel
(Hyamas et al, A. J. f Epidemiology, 2001)
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