Prevalence and Risk Factors of Hepatitis C Infection after Cardiac Surgery in Childhood before and after Blood Donor Screening

Abstract

After the implementation of blood donor screening, the risk for HCV infection after cardiac surgery in childhood dropped significantly from 14.6% to < 0.5%. These data show the necessity of HCV screening for patients at risk (operations before 1991) and do not favor a general screening for all patients.

The epidemiology of transfusion‐associated hepatitis C in a children's hospital

“…Only 487 actually refused testing. The mean number of contacts before patient enrollment was 3 Ϯ 3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], and the mean number of contacts for families refusing enrollment was 6 Ϯ 2 (range, 1-21); this difference was not significant.…”

“…Indeed, in a retrospective-prospective study of children in Germany first tested for HCV a mean of 19.5 years after their presumed exposure from transfusion during open heart surgery, 45 percent showed evidence of spontaneous viral clearance. 13 In another study of persons investigated 35 years after a common-source perinatal exposure, 42 percent had lost HCV RNA. 8 It is possible that a higher proportion of our patients will clear the virus over time, but in adults spontaneous viral clearance is extremely unusual after the first year of infection.…”

“…[1][2][3][4][5][6] In pediatric patients, maternal-infant and blood product transmissions are common, but the epidemiologic data, histologic findings, and clinical outcomes are conflicting. [7][8][9][10][11][12] Most studies have observed higher rates of spontaneous clearance 13 and slower disease progression in those infected at early age [5][6][7][8][9] but others suggest a more aggressive course, especially in those with existing malignancy. 14 In this study, we sought to identify and test a cohort of children transfused before the introduction of anti-HCV donor screening in an effort to establish the seroprevalence in this population; to annualize that risk in the decade before secondgeneration anti-HCV donor screening; to gather clinical outcome data, particularly as regards viral persistence and chronic hepatitis; and to establish the feasibility of a hospital-based universal lookback program.…”

The epidemiology of hepatitis C infection in the United States

“…59 Others at risk for more rapid fi brosis progression include individuals coinfected with HIV, 60 individuals with hypogammaglobulinemia infected by HCVcontaminated IV immunoglobulin, 61 and liver transplant recipients. 62,63 Groups associated with mild/moderate HCV-induced liver fi brosis include children infected in utero by HCV-infected mothers and those infected in childhood, [64][65][66] hemophiliacs infected by contaminated blood clotting factors, 67 individuals undergoing hemo dialysis, 68 women infected at young ages with contaminated anti-D immune globulin, 69 and women aged 20 years or less when infected through blood transfusion and others similarly affected. 70,71 Evaluation of the immunologic characteristics of these patient groups and studies of the characteristics of the associated viral strains (e.g., quasispecies variability) may provide clues to the mechanisms of HCV-induced disease progression.…”

Blood Conservation in Pediatric Cardiac Surgery

“…5 However, bacterial infections, ABO discrepancies and immunization still remain relevant today and justify the search for blood-sparing strategies. Furthermore, in pediatric cardiac surgery, stored blood in the priming solution has been shown to serve as a source of bradykinin, interleukins (IL) and inflammatory reactions leading to adverse effects.…”