Durand C M, Marr K A, Ostrander D, Subramanian A, Valsamakis A, Cox A, Neofytos D
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
The Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.
Transpl Infect Dis. 2016 Feb;18(1):146-9. doi: 10.1111/tid.12483. Epub 2016 Jan 30.
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.
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.
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.
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.
心室辅助装置（VAD）与免疫激活和致敏有关。我们在接受原位心脏移植（OHT）评估的患者中观察到几例假阳性（FP）丙型肝炎病毒（HCV）抗体（Ab）检测结果，促使我们对此进行进一步调查。
我们回顾了2005年至2012年约翰·霍普金斯医院所有VAD和OHT病例。FP HCV血清学定义为HCV Ab结果可疑或弱阳性，加上（i）重组免疫印迹（RIBA）和/或HCV核酸检测（NAT）阴性，或（ii）RIBA结果不确定且NAT阴性。
在53例接受HCV检测的患者中，近40%（21/53：39.6%）的患者在植入VAD后出现FP HCV Ab检测结果：4例患者NAT阴性，12例患者RIBA阴性，5例患者RIBA结果不确定且NAT阴性。所有RIBA结果不确定的患者对同一种HCV蛋白c100p/5-1-1p（NS4b蛋白）有单独反应性。在4例接受OHT并在移除VAD后进行重复HCV Ab检测的VAD患者中，3例患者的重复HCV Ab检测为阴性（OHT后699 - 947天）；1例患者的FP HCV血清学结果持续存在（OHT后5天）。13例患者仅接受了OHT，无一例出现FP HCV Ab。
植入VAD后出现FP HCV Ab结果非常常见。部分患者在移除VAD后FP血清学结果逆转，提示可能与VAD硬件有关。临床医生应意识到这一现象，因为它可能导致确定OHT资格的延迟并增加成本。
