INTRODUCTION: IVIG has become an essential tool in the treatment of sensitized patients prior to solid organ transplantation and is routinely used to treat viral infections in the transplant patient population. IVIG is prepared from the plasma of donors carefully screened for HIV, Hepatitis A, B, and C. Donors are screened for Hepatitis B with nucleic acid amplification technologies as well as screening for hepatitis B surface antigen. Hepatitis B core antibody positivity alone is not an exclusion criteria for donation and the passive transfer of Hepatitis B core antibodies has been documented. Our aim is to better determine the frequency of passive transfer of Hepatitis B core antibodies in order to prevent misdiagnosis and unnecessary treatment in the post-transplant period. METHODS: Monitoring of Hepatitis B serologies is done routinely in our sensitized patient population awaiting renal transplantation. Hepatitis B serologies are obtained in all patients prior to desensitization, during the desensitization period, and following transplantation. Hepatitis B serologies were reviewed for all patients who underwent renal transplantation between January 1^st and April 30^th 2015. RESULTS: 27 sensitized patients underwent pre-transplant immunomodulation and renal transplantation between January 1^st and April 30^th 2015. Of these 27 patients, 7 patients were found to have at least one positive Hepatitis B core antibody serology. Of these 7 patients, only 1 had documented Hepatitis B core antibody positivity prior to undergoing desensitization (immune due to natural infection). The remaining 6 appear to have developed positive serologic testing through the passive transfer of antibodies following IVIG administration. CONCLUSIONS: Hepatitis B core positivity is of significant clinical significance in patients preparing to undergo solid organ transplantation. Patients with true Hepatitis B core positivity prior to transplantation are often treated with nucleoside reverse transcriptase inhibitors post transplant with careful evaluation of liver function. Although repeat hepatitis B serologies are necessary to confirm return to negative serologic status, 22% of patients appear to have developed Hepatitis B core antibody positivity secondary to treatment with IVIG. It is thus important for clinicians to be aware that the passive transfer of Hepatitis B core antibody may be relatively common and should be considered before initiating treatment or excluding such patients from study trial entry.

CITATION INFORMATION: Nejad A, Vo A, Choi J, Jordan S. Transient Hepatitis B Core Positivity After Administration of IVIG for Desensitization (DES). Am J Transplant. 2016;16 (suppl 3).

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