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

Estimated Incidence of Acute HCV Infection, United States,

1960-2001

0

20

40

60

80

100

120

140

1960 1965 1970 1975 1980 1985 1989 1992 1995 1998 2001

Year

New

Infe

ctio

ns/1

00,0

00

Decline intransfusion recipients

Decline in injection drug users

Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S;CDC, unpublished data

Prevalence of HCV Infection by Age and Gender, United States

0

1

2

3

4

5

6

6-11 12-19 20-29 30-39 40-49 50-59 60-69 70+

Age in Years

% H

CV

+

Males

Females

Total

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)(Davis, LT 2003)

Background

• After successful introduction of screening for antibodies to the hepatitis C virus (HCV) in early 90’s, and more recently, also for HCV RNA, several authors reported a dramatic decrease of new acute HCV infections in the US (Hepatology 2000;31:777-82; Hepatology 1997;26:62S-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.

First results

0

2

4

6

8

10

12

2002 2003 2004 2005 2006

HC

V%% OPO 3 (S. Cal)

OPO 1 (N. Cal)

OPO 2 (N. Cal)

Aim

• To evaluate longitudinal trends in HCV prevalence among cadaveric organ donors from southern and northern California.

Specific Questions

• Is there a significant change or decrease in HCV sero-prevalence among transplant donors?

• What factors are associated with HCV positivity?

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

%HCV+ Donors in 3 CA OPOs

0

5

10

15

20

OPO 1 OPO 2 OPO 3Time Period

%02-0304-0506-07

Increase in OPO1, trend not significant in OPO 2 & 3

Year

P=0.01 P=NS P=NS

%HCV+ Donors by Donor Age

02468

101214161820

0-20 21-30 31-40 41-50 51-60 61-70 >70Donor Age

%OPO 1OPO 2

>80% HCV donors were between age 41-60

P<0.001 for both OPOs

%HCV+ Donors with other Serology

0

5

10

15

20

25

30

HIV HBsAb HBcAb EBV CMV

%HCV++

NegPos

P<0.001P=0.001

N=21 N=218 N=467 N=1169 N=3319

P=0.048 P=0.012

P<0.001

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 <40 or >60 1.77, 1.20-2.61 0.004

HBcAb+ HBcAb- 9.06, 6.17-13.3 <0.001

• Prevalence of HCV+ increased• HCV is almost twice as likely in 41-60 age group• 9 times more likely when HBcAb positive

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 HCV’s 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.

“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

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

Prevalence of antibody to hepatitis C virus among populations of US military Personnel

(Hyamas et al, A. J. f Epidemiology, 2001)