Donors In China Research Articles

Characterization of Occult Hepatitis B Virus Infection from Blood Donors in China

Prevalence and characteristics of occult hepatitis B virus (HBV) infection (OBI) of genotypes B and C prevalent in China have not been extensively explored. Characterization of OBI strains obtained from Chinese blood donors was based on clinical and serological analyses, follow-up testing, and sequence analyses. Twenty-eight samples from 165,371 HBV surface antigen (HBsAg)-negative plasmas were confirmed HBsAg negative and DNA positive(HBsAg(-)/DNA(+)), of which 22 were classified as OBIs and 6 as window period infections. The OBI incidence was 1:7,517 in blood donors, whose ages ranged between 20 and 45 years (median, 28 years). OBI donors had normal alanine aminotransferase (ALT) levels and low viral loads ranging between unquantifiable amounts and 178 IU/ml (median, 14 IU/ml). Sequences from 21 basic core promoter/precore (BCP/PC) regions, five whole genomes, and two additional pre-S/S regions from OBI strains were compared to genotypes B and C HBsAg(+) reference strains. Eighty-six percent (6/7) of OBI strains were genotype C. Deletions, insertions, stop codons, and substitutions were detected in 15/21 (71%) core regulatory elements of OBI strains. Critical mutations were found in the core proteins of 5/5 OBI strains in parallel with random substitutions in pre-S/S proteins from 6/7 (86%) OBI strains. Critical mutations in core regulatory elements and core proteins might affect OBI genotype B and C strain replication. That there were few S protein substitutions suggests a minor role of the host immune defenses in OBI occurrence.

New trends of HCV infection in China revealed by genetic analysis of viral sequences determined from first-time volunteer blood donors.

Recently, we studied hepatitis C virus (HCV) sera-prevalence among 559 890 first-time volunteer blood donors in China. From randomly selected 450 anti-HCV positive donors, we detected HCV RNA in 270 donors. In this study, we amplified HCV E1 and/or NS5B sequences from 236 of these donors followed by DNA sequencing and phylogenetic analysis. The results indicate new trends of HCV infection in China. The HCV genotype distribution differed according to the donors’ region of origin. Among donors from Guangdong province, we detected subtypes 6a, 1b, 3a, 3b, 2a, and 1a at frequencies of 49.7%, 31.0%, 7.6%, 5.5%, 4.1%, and 2.1%, respectively. Among donors from outside Guangdong, we detected 1b, 2a, 6a, 3b, 3a, 6e, and 6n at frequencies 57.1%, 13.2%, 11.0%, 9.9%, 4.4%, 2.2%, and 2.2%, respectively. Although we found no significant differences among regions in age or gender, subtype 6a was more common (P< 0.001) in donors from Guangdong than those from elsewhere, whilst subtypes 1b (P< 0.02) and 2a (P < 0.001) were more frequent outside Guangdong. Disregarding origins, the male/female ratio was higher for subtype 6a-infected donors (P < 0.05) than for subtype 1b donors, whilst the mean age of subtype 2a donors was 8–10 years older (P < 0.05) than that for all other subtypes. Detailed phylogenetic analysis of our sequence data provides further insight into the transmission of HCV within China, and between China and other countries. The predominance of HCV 6a among blood donors in Guangdong is striking and mandates studies into risk factors for its acquisition.

Predonation Quality of Life and Early Postdonation Safety of Older Living Renal Donors in China

Background Studies on the safety of older living renal donors are lacking in China. Methods We observed 142 consecutive living renal donors before and early after (7 days) the operation. There were no prisoners used as donors or recipients. Subjects were divided into 2 groups: older than 50 years of age ( n = 40) or younger age ( n = 102). We compared differences in early safety between the 2 groups. Results There were no significant differences in 8 aspects of the predonation quality of life using the SF-36 questionnaire, except for physical function ( P < .001). Zero hour biopsies performed on 52 kidneys showed 15 to display abnormal renal tissues (28.85%), which was significantly greater among the older age group ( P = .034). The perioperative indexes were similar between the 2 groups; however, the hospital stay was longer in the older group ( P = .034). Compared with the younger group, the older group generally showed a lower creatinine clearance (CCr; P < .001), higher cystatin c ( P = .006), and similar serum creatinine (Scr) preoperatively, conditions that persisted at 7 days postoperatively. Although the increased Scr and reduced CCr were present in all donors, the changes in Scr and CCr were similar between the 2 groups. Differences in urinary micro-albumin and proteinuria before and after operation were not significantly different for both groups. Conclusions Increased use of older living kidney donors in China may be a safe strategy to meet the demand for transplantation. However, long-term outcomes need further follow-up.

Anti-HCV reactive volunteer blood donors distribution character and genotypes switch in Xi'an, China

HCV is prevailed in the world as well as in China. Blood transfusion is one of the most common transmission pathways of this pathogen. Although data of HCV infection character were reported during the past years, anti-HCV reactive profile of China donors was not fully clear yet. Furthermore, infection progress was found related to the HCV genotype. Different genotype led to different efficacy when interferon was introduced into HCV therapy. Here we provided character data of HCV infection in China blood donors from the year of 2000 to 2009. The infection rate in local donors was lower than general population and descended from 0.80% to 0.40% or so in recent years. About 83% HCV strains were categorized into genotypes 1b and 2a. But 1b subtype cases climbed and 2a subtype cases decreased. The current study threw more light on HCV infection of blood donors in China, at least in the Northern region.

Alterations of CD4+CD25+Foxp3+ regulatory T cells in HIV‐infected slow progressors of former blood donors in China

Our objective was to study the alterations of CD4(+) CD25(+) Foxp3(+) T(regs) in HIV-infected SPs and to examine the role of T(regs) in the disease progression of HIV. The proportion of CD4(+) CD25(+) Foxp3(+) T(regs) in peripheral blood of 24 SPs, 30 asymptomatic HIV-infected patients, 20 AIDS patients, and 16 non-infected controls was quantified using flow cytometry. HIV Gag peptide mix-induced IFN-γ expression in CD8(+) T cells in whole and CD25-depleted PBMCs was examined to evaluate the function of T(regs) . The expression of CTLA-4 in T(regs) was also detected to measure the suppressive effect of T(regs) . HLA-DR and CD38 expression were measured to study the relationship between the frequency of T(regs) and immune activation of HIV-infected patients. The frequency of CD4(+) CD25(+) Foxp3(+) regulatory T cells in SPs was lower than in asymptomatic HIV-infected patients, AIDS patients, and normal controls (P < 0.05). T(regs) in SPs showed lower intracellular CTLA-4 expression than those of asymptomatic HIV-infected patients and AIDS patients (P < 0.05). The frequency of T(regs) significantly correlated with the percentage of CD38 expression on CD4(+) and CD8(+) T cells (P < 0.05). Multivariate regression analysis showed that the CD4(+) T cell count was the strongest independent factor correlated with the absolute count of T(regs) , while viral load had the strongest predictive strength on the proportion of T(regs) . We conclude that a lower frequency of T(regs) and intracellular CTLA-4 expression of T(regs) was one of the characteristics of SPs that may have important clinical impacts for the prediction of the clinical progress of HIV infection.

The seroprevalence of hepatitis C virus (HCV) among 559,890 first-time volunteer blood donors in China reflects regional heterogeneity in HCV prevalence and changes in blood donor recruitment models.

A decrease in the prevalence of hepatitis C virus antibody (anti-HCV) has been reported among voluntary blood donors in some regions of China. However, the prevalence of HCV among volunteer blood donors in other regions of China has not been reported. The aim of this study was to investigate the seroprevalence of HCV among 559,890 first-time volunteer blood donors recruited during 2004 through 2007 at the Guangzhou Blood Center, China. Anti-HCV was detected using two different third-generation enzyme immunoassay kits. HCV RNA was detected using reverse transcription-polymerase chain reaction (RT-PCR) targeting the 5'-untranslated region of HCV. Among 559,890 donors, 1877 (0.335%) were positive for anti-HCV. The anti-HCV+ rate was significantly higher in males than females (0.37% vs. 0.28%; p < 0.001) and significantly lower among donors living in Guangdong Province than donors who had migrated from other locations (0.30% vs. 0.40%; p < 0.001). Among the 1877 anti-HCV+ donors, 450 were randomly selected for HCV nucleic acid amplification by RT-PCR. Of these, 270 (60%) were HCV RNA+ and 180 (40%) were HCV RNA-. Many donors from outside Guangdong Province were migrant laborers from other areas in China, suggesting that there is regional heterogenicity in HCV prevalence within China. The overall anti-HCV+ rate reported here is among the lowest reported among blood donors in China reflecting the effect of the current recruitment of exclusively volunteer donors.

Real-Time Quantitative Polymerase Chain Reaction With SYBR Green I Detection for Estimating Copy Numbers of Porcine Endogenous Retrovirus From Chinese Miniature Pigs

Porcine endogenous retrovirus (PERV) in the pig genome represents a potential infectious risk in xenotransplantation. Chinese miniature pigs have been considered to be potential organ donors in China. However, an adequate level of information on PERV from Chinese miniature pigs has not been available. We established an SYBR Green I-based real-time quantitative polymerase chain reaction (PCR) assay for estimating copy numbers of PERV integrated in the host genome. The assay was 100-fold more sensitive compared with conventional PCR. We also evaluated the specificity and reproducibility of the assay. We statistically analyzed the difference in PERV copy numbers integrated into the genomes of Wuzhishan pigs versus Bama minipigs. This approach will be useful to screen donor pigs as well as to examine clinical samples from human subjects treated with porcine xenotransplantation products for evidence of PERV transmission.

Incidence and nature of cognitive decline over 1 year among HIV-infected former plasma donors in China

To quantify and characterize the nature of cognitive change over 1 year in a cohort of HIV-positive former plasma donors in rural China. The present study is an observational cohort study. One hundred and ninety-two HIV-positive and 101 demographically comparable HIV-negative individuals, all former plasma donors, who lived in a rural part of China, received comprehensive medical and neuropsychological examinations. At study entry, 56% of HIV-positive group was on combination antiretroviral treatment and 60.9% at follow-up. Multiple regression change score approach was used with the HIV-negative sample to develop norms for change that would be then applied to the HIV-positive participants. Follow-up test scores adjusted for the control group practice effect. Fifty-three HIV-positive individuals (27%) developed significant cognitive decline as compared with five (5%) HIV-negative individuals. Cognitive decline was predicted at baseline by AIDS status, lower nadir CD4, and worse processing speed; at follow-up, it was associated with lower current CD4 cell count and failure of viral suppression on combination antiretroviral treatment. Neuropsychological decline also was associated with decreased independence in activities of daily living. Using neuropsychological impairment scores that were corrected for 'practice' on repeated testing, we found that among the decliners, 41.5% (N = 22) had incident impairment, whereas 38% (N = 20) declined within the impaired range and another 20.7% (N = 11) declined within the normal range. The present study demonstrates that despite ongoing combination antiretroviral treatment, cognitive decline in HIV-positive people is common over a 1-year follow-up. Regression-based norms for change on western neuropsychological tests can be used to detect disease-related cognitive decline in a developing country.

Evaluation of living related kidney donors in China: policies and practices in a transplant center

Rigorous donor evaluation is essential for living related donor kidney transplantation (LRDKT). However, guidelines for living kidney donor evaluation are absent in China. The aim of this study is to describe the initial experience in the living kidney donor evaluation process in a single transplant center in China. The evaluation process of our center is sequentially divided into five steps: outpatient consultation and information, preliminary evaluation, comprehensive evaluation, final informed consent, and ethics committee oversight. Between June 2007 and March 2009, 124 potential living donors were evaluated in our center, of whom 82 (66.1%) became effective donors and the remaining 42 (33.9%) were excluded. The exclusion reasons were related to clinical problems in 27 cases, psychosocial problems in seven cases, and suspected organ trading in eight cases. Although strongly forbidden by Chinese laws, organ trading remains a threat to the healthy development of LRDKT in China. To prohibit organ trading, the kinship between the donor and recipient should be carefully identified. Guidelines for living donor evaluation appropriate to the actual situation in China should be set up for the sake of safety and to protect the rights and interests of both donors and recipients.

Supply and demand in transplant tourism: Disclosure duties of the transplant physician and our global transplant community

Faced with a poor prognosis without transplantation, desperate patients with end-stage liver disease often reach for any means to prolong their lives. These patients, who resort to transplant tourism, are an especially vulnerable population who may be unaware of the substantial risks associated with organ transplantation practices in many areas of the world. I read with great interest the recently published article by Fan et al.1 documenting the dramatically higher hepatocellular cancer recurrence rates and markedly reduced posttransplant survival rates of recipients who traveled to mainland China for liver transplantation in comparison with those who stayed in Hong Kong. This is valuable evidence of the recipient outcomes of liver transplantation in mainland China and should be proactively shared with patients who are considering transplant tourism. Fan et al.1 reported a recipient survival rate after liver transplantation at their center (Queen Mary Hospital, Hong Kong) that compares favorably with the rates at leading centers worldwide. The authors' efforts to accurately quantitate outcomes at other centers in mainland China are commendable. Recipient selection and donor characteristics are likely influential drivers of the reported outcomes. In their article, organ donors are described as “probably more akin to uncontrolled non–heart-beating donors” for the mainland China cohort. Although the authors are circumspect regarding whether the donors were actually executed prisoners, it seems likely that this was the donor population.2 Although leading destination countries for transplant tourism include China, India, the Philippines, and Pakistan, transplant tourism to mainland China has been isolated as particularly controversial.3-6 Organ procurement from executed prisoners in China has been reported by nongovernmental investigative reports and in the medical literature.2-4 These reports indicate that as many as 95% of organ donors in China are prisoners. Indeed, Dr. Jiefu Huang, Vice Minister of Health in China, reported that “apart from a small portion of traffic victims, most of the cadaveric organs come from executed prisoners.”2 Both live and deceased donor organ procurement from prisoners violates US and international professional guidelines and international standards ratified by the World Medical Association in its statement on human organ donation and transplantation.7-9 These international ethical guidelines exist to ensure that the donation of organs is voluntary, both in life and after death. Because not all countries adhere to these ethical guidelines, when traveling to another country for organ transplant surgery, patients risk using an organ obtained in an unsafe or unethical manner.10, 11 Full disclosure, in scientific reports and at the bedside, is an imperative for our transplant community.5, 12, 13 Laudable efforts aimed at broadening the use of live donor organ donation and donation after brain death in China have the potential to mitigate China's dependence on executed prisoners as the dominant donor pool.14 Transplant physicians are obliged to inform patients considering transplant tourism about both the personal risks of inferior transplant outcomes and the potential for contributing to the demand for practices that may violate human rights.10 Yet, action by international regulatory and credentialing bodies, such as the Joint Commission International, may be required to ensure patient safety and the adherence to internationally accepted ethical standards in organ transplantation.10, 12 Scott W. Biggins M.D., M.A.S.*, * Gastroenterology Health Outcomes, Policy and Economics Program, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA.

Two novel null alleles of the KEL gene detected in two Chinese women with the Knull phenotype

In screening 87665 unrelated healthy blood donors in China, serology studies resulted in the detection of two K(0) probands, both female. To explore the molecular basis of the K(null) phenotype in the Chinese population, genomic DNA, total RNA, and reticulocyte RNA were subsequently prepared from the two probands, five family members of proband 1, four unrelated normal controls, and one unrelated KEL1 control. Nucleic acids were analyzed for the KEL gene by DNA and RNA sequencing, while antigens were analyzed by flow cytometry with BRIC18, BRIC68, anti-k, and anti-Kp(b). Two novel K(null) alleles were identified in both probands: in exon 3, 185insT (Ser62Phe and a premature stop codon in exon 4, GenBank accession number, EF208900), and in exon 7, 715G>T (Glu239Stop, GenBank accession number EF208901). Alternative splicing patterns were observed in RNA obtained from whole blood versus from a reticulocyte fraction. Our study identified these two novel K(null) alleles resulting in the K(null) phenotype, the frequency of the K(null) phenotype amongst Chinese mainlanders is only 0.00228%.

Cross-reactive Antibodies against Avian Influenza Virus A (H5N1)

Cross-reactive Antibodies against Avian Influenza Virus A (H5N1)

Evaluation of Immunoglobulin M and G Western Blot and ELISA for Screening Antibodies to Treponema pallidum in Blood Donors

Enzyme-linked immunosorbent assay (ELISA) is the most popular method used by blood banks in China to screen for antibodies to Treponema pallidum (TP). However, this method produces a high percentage of false-positive reactions.The current study aimed to propose a more effective procedure for screening anti-TP antibodies in blood donors. A total of 1009 serum samples showing repeat reactivity in routine blood bank procedures were tested with a TP particle agglutination assay (TPPA) and 3 commercially available ELISA tests. Samples showing reactivity with any of these methods were further tested by Western blot (WB) and ELISA immunoglobulin G (IgG)and immunoglobulin M (IgM) anti-TP assays. Of the 1009 samples tested, 170 were identified as reactive with at least one of our methods. In these 170 samples, excluding borderline cases, the agreement of the WB method with TPPA, Murex, BGI, and InTec ELISA tests was 76.0%, 77.8%, 78.4%, and 80.1%, respectively. With the WB results as the reference, the sensitivity of TPPA, Murex, BGI, and InTec ELISA tests was 91.5%, 95.4%, 99.2%, and 98.5%, respectively. TpN17 and TpN15 are the most important antigens in the antibody response of IgM and IgG, respectively. The WB IgM and IgG results suggest that the seroprevalence of anti-TP in blood donors in China is 0.49% (130/26,702). A combination of routine ELISA methods and WB IgM and IgG may be a valid procedure for the confirmatory testing of anti-TP antibodies and would be beneficial for screening blood donors.

Solidarity and Distinction in Blood: Contamination, Morality and Variability

This is an ethnographic exploration into the meanings of contaminated blood. Intense commercial harvesting of human plasma, a blood component, in rural central China during the 1990s resulted in extensive HIV infection among donors. The lack of viral diversity among these infected donors, as revealed by research in molecular epidemiology, confirms that this epidemic took hold and spread rapidly with deadly efficiency through unsanitary plasmapheresis. The distinction in viral strains between this epidemic and the spread of HIV via other routes of transmission in other parts of China serves also to promote claims to victimhood by infected rural commercial donors in the ambiguous geography of moral ambivalence towards carriers of the virus. Through a series of vignettes from field research among rural plasma donors in China, this article examines the tensions between solidarity and distinction, victimhood and responsibility, alliance and strife as they play out in meanings derived from contaminated blood, within their everyday experience and also within their participation in the broader HIV/AIDS activism, in which their distinction is inevitably challenged.

Stress and Coping in HIV-Positive Former Plasma/Blood Donors in China: A Test of Cognitive Appraisal Theory

Throughout the 1990s, many villagers in rural China were infected with HIV through commercial plasma/blood donation. These former plasma/blood donors (FPDs) experienced many HIV-related stressors. This study tested a cognitive appraisal model of stress and coping in a sample of HIV-positive adult FPDs. Participants (N = 207) from multiple villages completed a battery of questionnaires assessing HIV-related stress, HIV symptoms, cognitive appraisal, coping behaviors, and psychological distress. Participants reported high levels of HIV-related stress, depression, and anxiety. In a structural equation model, greater HIV-related stress, HIV symptoms, and threat appraisal were directly associated with psychological distress. HIV-related stress was also indirectly associated with psychological distress through threat appraisal. In a second model, coping was found to mediate the relationship between challenge appraisal and psychological distress. Results support the utility of cognitive appraisal theory. Stress management interventions targeting HIV-positive FPDs in China are indicated.

Editorial Commentary:Antiretroviral Therapy for Former Plasma Donors in China: Saving Lives When HIV Prevention Fails

The spread of HIV and other bloodborne infections in rural communities in east-central China in the late 1980s and early 1990s was a tragic public health event. This occurred at a time of great transition. A market-oriented economy was emerging across the country and the commune-based rural health care system was collapsing. From the 1950s through the 1970s China had established a 3-tiered health care infrastructure including village barefoot doctors township health care centers and county hospitals and a low-cost Cooperative Medical System that provided basic health insurance. This primary care infrastructure and basic insurance scheme served rural residents efficiently during a time that 180% of all Chinese persons lived in rural areas (compared with 50%-60% in 2008). The infant mortality rate decreased from ~200 of 1000 live births in 1949 to 47 of 1000 live births in 1975 and life expectancy increased from 35 years in 1949 to 65 years in 1975. Chinas gross national income per capita in 1975 was only $230 suggesting that the improvement in health indices was an extraordinary public health and primary care achievement.

The Effect of Highly Active Antiretroviral Therapy on Mortality among HIV‐Infected Former Plasma Donors in China

In China, many former plasma donors were infected with the human immunodeficiency virus (HIV) in the early-mid-1990s. Highly active antiretroviral therapy (HAART) was provided for former plasma donors beginning in 2002. The effect of HAART on mortality in this cohort has not been described. This study is a retrospective analysis of the national HIV epidemiology and treatment databases for the period 1993-2006. All HIV-infected subjects from 10 counties with a high prevalence of HIV infection in 6 provinces were eligible. Inclusion criteria were: (1) history of plasma donation, (2) positive Western blot result, (3) clinical diagnosis of AIDS or CD4(+) cell count <200 cells/microL at any time, and (4) age >or=18 years at AIDS diagnosis. Of 9059 eligible subjects, 4093 met the inclusion criteria. Mean age was 41 years, 51% were male, 99% were farmers, and 87% were from Henan Province. Overall mortality decreased from 27.3 deaths per 100 person-years in 2001 to 4.6 deaths per 100 person-years in 2006. Conversely, the percentage of patient-years receiving HAART increased from 0% in 2001 to 70.5% in 2006. In a multivariate Cox proportional hazards analysis, not receiving HAART was the greatest risk factor for mortality (hazard ratio, 2.8; 95% confidence interval, 2.4-3.3). Among treated patients, those who had lower CD4(+) cell counts and higher numbers of opportunistic infections at the initiation of therapy were at greater risk of death. The national treatment program has significantly reduced the mortality rate among HIV-infected former plasma donors through the use of generic drugs in a rural treatment setting with limited laboratory monitoring. Treatment success can be improved through increased coverage and earlier initiation of therapy.

Identification of 11 novel HLA alleles found during typing of unrelated registry donors in China

Eleven novel human leukocyte antigen (HLA) alleles were identified during routine sequence-specific oligonucleotide probe (SSOP) typing (LABType; One Lambda Inc., Los Angeles, CA) of volunteers for a hematopoietic stem cell registry in Beijing, China. The new alleles were detected when one or more probes gave an unexpected reactivity pattern.

Current Knowledge and Attitudes About Organ Donation and Transplantation Among Chinese University Students

Current attitudes toward organ donation among university students in mainland China and the differences in attitudes between Chinese students in mainland China versus overseas are unknown. To address these issues, we conducted a cross-sectional survey using questionnaires among 922 Chinese undergraduates from mainland China and overseas regions of the world. Data were analyzed by descriptive statistics, Student t tests, chi-square tests, and a logistic regression analysis. We found that blood donors showed significantly better awareness of heart, liver, lung, skin, and tendon donation among commonly transplanted organs/tissues. As to the willingness for cadaveric organ donation, 61.3% of respondents consented, 8.5% objected, and 30.3% answered “not sure.” The percentage holding an organ donor card was 15.7% among students from Hong Kong; 3.0%, mainland China; 2.8%, Macau; 2.6%, Taiwan, and 4.0%, other regions of the world. In a logistic regression analysis, female students (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.35 to 3.72) and blood donors (OR, 1.91; 95% CI, 1.10 to 3.32) did, but age and study specialty (medical vs nonmedical) did not show significantly more positive attitudes toward cadaveric organ donation. Compared with students from mainland China, overseas Chinese students from various regions did not show significantly different attitudes toward cadaveric organ donation. In summary, blood donors among university students have a greater knowledge of transplantation and a more positive attitude toward organ donation. Since university students are an important source of blood donors in China, they will be a potential pool of organ donors in the future.

Epidemiologic study and HLA analysis of highly exposed to HIV but persistently seronegative subjects (HEPS) in commercial blood donors in China

To investigate epidemiology and HLA typing of highly exposed to HIV but persistently seronegative subjects (HEPS) in commercial blood donors in China. This was a cohort study for epidemiologic characteristics of highly exposed but persistently seronegative subjects. PCR with sequence-specific primer and PCR-SSP for HLA typing were applied. Eight HEPS were identified. Compared HLA typing with seropositive couple, high frequency of HLA-a24, HLA-B40 genotyping was observed. Highly exposed to HIV but persistently seronegative subjects in commercial blood donors in China had high frequency of HLA-A24 and HLA-B40 genotype.