False-positive hepatitis C virus serology after placement of a ventricular assistance device

• Published in: Transplant infectious disease 2016-02, Vol.18 (1), p.146-149
• Main Authors: Durand, C.M., Marr, K.A., Ostrander, D., Subramanian, A., Valsamakis, A., Cox, A., Neofytos, D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; False Positive Reactions; false-positive hepatitis C virus serology; Female; Heart-Assist Devices - virology; Hepacivirus - genetics; Hepacivirus - immunology; Hepacivirus - isolation & purification; Hepatitis; Hepatitis C - diagnosis; Hepatitis C - virology; Hepatitis C Antibodies - blood; Humans; left ventricular assist device; Male; Middle Aged; Nucleic acids; orthotopic heart transplant; panel reactive antibodies; Retrospective Studies; RNA, Viral - blood; sensitization; Serologic Tests; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12483

Background Ventricular assist devices (VADs) have been associated with immune activation and sensitization. We observed several cases of false‐positive (FP) hepatitis C virus (HCV) antibody (Ab) tests in patients being evaluated for orthotopic heart transplant (OHT), prompting us to investigate this further. Methods We reviewed all VAD and OHT cases at Johns Hopkins from 2005 to 2012. FP HCV serology was defined as an equivocal or low‐positive HCV Ab, plus either (i) a negative recombinant immunoblot (RIBA) and/or HCV nucleic acid test (NAT), or (ii) an indeterminate RIBA and negative NAT. Results In 53 patients with available HCV testing, nearly 40% of patients (21/53: 39.6%) developed FP HCV Ab tests after VAD placement: 4 patients had negative NAT, 12 had negative RIBA, and 5 had an indeterminate RIBA and negative NAT. All patients with indeterminate RIBA tests had isolated reactivity to the same HCV protein, c100p/5‐1‐1p (NS4b protein). In 3 of 4 VAD patients who had OHT and repeat HCV Ab testing after VAD removal, repeat HCV Ab was negative (699–947 days after OHT); in 1 case, FP HCV serology persisted (5 days after OHT). Thirteen patients had OHT alone and none developed a FP HCV Ab. Conclusions FP HCV Ab results following VAD placement are very common. Reversal of FP serology in several patients after VAD removal is suggestive of a possible association with the VAD hardware. Clinicians should be aware of this phenomenon, as it could lead to delays in determining eligibility for OHT and increased costs.