Hepatitis C in blood transfusion recipients identified at the Oxford Blood Centre in the national HCV look‐back programme

Abstract

After the introduction in September 1991 of donor screening for hepatitis C, 95 potentially infectious blood donors who had given blood before this date were identified at the Oxford blood centre. Three hundred and ninety-nine blood components issued previously from these donors were identified in the course of the national HCV look-back programme. Of 399 questionnaires sent to hospital blood banks 392 were returned, identifying 290 recipients of whom 177 (61%) had died, and 113 (39%) were still alive 4-13 years after transfusion. One hundred and four recipients were traced and tested. Forty-nine recipients were not HCV infected. Forty-four of 58 (76%) recipients who received blood from donors found to be HCV RNA positive after September 1991 gave positive test results for HCV RNA. Eleven of 58 showed only antibody (anti-HCV), and 3/58 who had apparently received infectious blood showed no sign of past infection. The 11 who showed anti-HCV only, together with the three who showed no sign of past infection despite strong evidence of receiving HCV RNA-positive blood, had a mean age at transfusion of 27 years, compared with mean age at transfusion of 46 years in the 44 recipients with persistent HCV infection. Virus genotyping in 33/44 HCV RNA-positive recipients revealed five different genotypes. These did not seem to influence the outcome. Virus genotypes in 31 donor-recipient pairs showed complete concordance. Liver biopsies in 23/44 RNA-positive recipients showed minimal inflammation in four, mild in eight and moderate in 11. Liver fibrosis, Ishak grades 1-3, was present in 16/23 recipients. One other male recipient, not subjected to a liver biopsy, developed a hepatocellular carcinoma which caused his death at the age of 71, 8 years after transfusion.

Transfusion transmission of HCV infection before anti‐HCV testing of blood donations in England: results of the national HCV lookback program

“…Unlike some other analyses, 5 we did not identify any factors affecting PCR status in those infected.…”

“…The single‐donor‐recipient series did not (due to uncertainty about a number of variables) contribute good evidence about whether transfusion transmission had occurred in individual cases. In studies where serotyping or genotyping has been performed on these donor‐recipient pairs, high concordance has supported transfusion as the source of these infections 5,6 . Unless there is definite evidence of pre‐existing infection, or of a very probable other source, it seems reasonable to assume that the lookback transfusion was the source of infection.…”

“…The purpose of this lookback was stated by the Chief Medical Officer in April 1995 as “to trace, counsel and if necessary treat patients exposed to HCV infection prior to September 1991 by transfusion.” 3 This program is still ongoing, however the bulk of recipient tracing and testing occurred between the start of the program in 1995 and the end of 1997. Some data from this program have already been published 4‐6 . This paper presents nationally collated data about the program's outcomes and some analyses of a large data set to investigate the effects of multiple variables on lookback outcome and on transfusion transmission of HCV.…”

Diversity of Hepatitis C Virus Quasispecies Evaluated by Denaturing Gradient Gel Electrophoresis

“…It may be that the multiple HCV transmission events hypothesized to occur in IDUs are, for various reasons, not associated with an increase in genetic complexity. In addition to this, the epidemiology of HCV in blood donors is poorly understood (5). Seropositive blood donors may thus be as susceptible to HCV multiple transmission as are IDUs through a variety of unknown routes.…”

Introduction of a Central Documentation of Blood Products according to §§ 14 and 17 Transfusionsgesetz (TFG) by a Computerized Blood Bank Data System

“…Previously published data from look-back procedures showed that it is often impossible to confirm that the patient had received the component. Information about transfusions performed was missing in hepatitis C look-back studies in 8.7% [3], 9% [4], 10% [5], and up to 16% [6] due to the untraceability of the blood product. The computerized documentation system used in our department before September 1999 documented only the patient and the ward where the blood products were delivered to.…”