Outcome of post-transfusion hepatitis C: disease severity in blood- component recipients and their implicated donors

Abstract

The UK 'Look-back Program' identifies recipients of blood products from hepatitis C antibody (anti-HCV) positive donors. Of 60 such recipients tested by the Newcastle Transfusion Service, 28(46.7%) were anti-HCV-negative, 25(41.7%) were anti-HCV-positive, and seven (11.6%) had equivocal serology. We studied 29 anti-HCV-positive/indeterminate recipients and eight of their implicated donors, using serial liver function tests (LFTs), liver histology when clinically indicated, HCV RNA and serotyping. Presumed resolved hepatitis C, with persistently normal LFTs and negative HCV RNA, was found in 28%, of whom 63% had indeterminate anti-HCV by RIBA (1 band of 4 detected on third-generation recombinant immunoblot assay). Resolved hepatitis C was significantly more common in women (p < 0.05) and tended to be associated with younger age at transfusion. There was complete concordance in serotype between donor-recipient pairs. There was no correlation in disease severity between recipients and their implicated donors, nor between recipients from the same donor. A history of alcohol consumption above recommended 'safe' limits (median 30 units) was associated with more severe histological disease (p < 0.01). Host factors, including gender and alcohol consumption, may be important in determining the wide variability in outcome of post-transfusion hepatitis C.

Transfusion‐acquired hepatitis C: the Danish lookback experience

“…Our serologic results are in accordance with reports in the literature 5–14 . In these studies, results in 294 recipients tested by second‐ or third‐generation assays were reported: 72 percent were ELISA positive, 59 percent were RIBA positive, and 59 percent were HCV RNA positive (HCV RNA results were reported for only 215).…”

“…Previous pilot lookback testing of transfusion recipients in Europe has shown that 57 to 100 percent were infected with HCV but several studies have indicated that the yield in terms of recipients who would possibly benefit from the lookback initiative is very low 5–14 . Thus, the national lookback in Denmark was initiated as a political decision rather than as the result of a cost‐benefit analysis.…”

Four‐year survival of transfusion recipients identified by hepatitis C lookback

“…The proportion of patients identified by HCV lookback who were dead at the time of this lookback investigation (478 of 695 or 68.8%) was similar to that reported from other studies, 1,18‐28 and it was identical to the proportion (69%) reported by Culver et al 27 who pooled the experience of 81 percent of blood centers and 64 percent of transfusion services in the United States. Other lookback investigations of recipients of units potentially contaminated with HCV found that from 39 to 80 percent of identified transfusion recipients were dead by the time of the study 1,18‐26,28 . Investigation of the probability of survival of transfusion recipients was not an objective of these studies, 8 however, and it is difficult to infer the length of recipient follow‐up from the published data.…”

“…Probabilities of survival at 1, 2, or more years after transfusion were not calculated. Moreover, the time that had elapsed between transfusion and the undertaking of each lookback investigation varied greatly among the reports, and many of these studies 1,18‐28 did not report information on the case mix, transfusion dose, and/or age and gender composition of the transfusion recipients.…”

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

“…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.…”