Risk of Window Period Hepatitis-C Infection in High Infectious Risk Donors: Systematic Review and Meta-Analysis

Abstract

The OPTN classifies high infectious risk donors (HRDs) based on criteria originally intended to identify people at risk for HIV infection. These donors are sometimes referred to as 'CDC high risk donors' in reference to the CDC-published guidelines adopted by the OPTN. However, these guidelines are also being used to identify deceased donors at increased risk of window period (WP) hepatitis C virus (HCV) infection, although not designed for this purpose. The actual risk of WP HCV infection in HRDs is unknown. We performed a systematic review of 3476 abstracts and identified 37 eligible estimates of HCV incidence in HRD populations in the United States/Canada. Pooled HCV incidence was derived and used to estimate the risk of WP infection for each HRD category. Risks ranged from 0.26 to 300.6 per 10 000 donors based on WP for ELISA and 0.027 to 32.4 based on nucleic acid testing (NAT). Injection drug users were at highest risk (32.4 per 10 000 donors by NAT WP), followed by commercial sex workers and donors exhibiting high risk sexual behavior (12.3 per 10 000), men who have sex with men (3.5 per 10 000), incarcerated donors (0.8 per 10 000), donors exposed to HIV infected blood (0.4 per 10 000) and hemophiliacs (0.027 per 10 000). NAT reduced WP risk by approximately 10-fold in each category.

Prevalence of Antibodies to Hepatitis C Virus in Voluntary Blood Donors: Are Women Better Donors?

“…This does not detect individuals in window period, which is much longer for HCV infection, approximately 66 days, due to delayed antibody production [33,34]. Thus, an antibody based detection fails to diagnose the infection during this period.…”

New Solutions to Reduce Discard of Kidneys Donated for Transplantation

“…For recipients of PHS infectiousrisk kidneys, the estimated rates of HIV transmission are lower than those for HCV. 23,24 By comparison, the annual death rate for wait-listed patients is approximately 4% and higher for subgroups with diabetes or over 60 years of age. 25 Post-transplant patient and allograft survival appear to be similar between recipients of PHS infectious-risk versus standard criteria organs, 26 which is not surprising given the tiny predicted rates of disease transmission.…”

Donor-Derived Infection: Epidemiology and Outcomes

“…The PHS is currently working on a revision of these risk factors that should be finalized by late 2012 [13]. A recent metaanalysis demonstrated that for hepatitis C, the highest risk (without NAT screening) of window period infection was 300/10,000 donors for injection drug users [43]. For window period HIV infection, the highest risk was for men who have sex with men (10.2/10,000) and intravenous drug users (12.1/10,000) [44].…”