The Risk of HBV Breakthrough Infection in Immunosuppressive Patients with High Ratio of HBcAb-Positive Blood Components Transfusion

Background & Aims: Immunosuppressive therapy may cause hepatitis B virus (HBV) reactivation in patients with HBcAb-positive, but the impact of HBcAb-positive blood components transfusion is poorly defined. This study aimed to evaluate the risk of HBV breakthrough infection in immunosuppressed children patients with a high HBcAb-positive blood components transfusion in HBV highly endemic areas. Methods: Children patients with acute lymphoblastic leukemia (ALL) will undergo routine blood transfusions. Cohort study was conducted in ALL children receiving blood components transfusion during chemotherapy from Sep, 2012 to Aug, 2018. Eligible children were hepatitis B surface antigen (HBsAg) and HBcAb-negative pre-transfusion. The main outcome was HBsAg or HBV DNA detected during immunosuppressive therapy. Findings: HBV breakthrough infection was identified in 0.98% (4/410) of children during immunosuppressive therapy. Among the four breakthrough patients, there were both one family with HBV infection history and one without. The appearance of HBcAb-positive was transient after blood transfusion (from 6.3% to 37.7%, eventually dropped to 0.67%). Meanwhile, HBsAb levels had significantly decreased during immunosuppressive therapy (from 63.0% to 37.4%). Interpretation: The risk of HBV breakthrough infection in immunosuppressive children patients is relatively low, even with the high radio of HBcAb-positive blood components transfusion. The patients should be paid special attention who with the existing occult HBV infection or have a family HBV infection history. Clinically, there is no need to worry about the sudden rising of HBcAb after blood transfusion. Funding Info: This study was supported by the National Natural Science Foundation of China (No.81371876), National Clinical Research Center for Child Health and Disorders General Project (No. NCRCCHD-2019-GP-04), Outstanding Youth Foundation of Children's Hospital of Chongqing Medical University. Declaration of Interests: We declare no competing interests. Ethical Statement: This study was approved by the Ethics Review Committee of Children’s Hospital of Chongqing Medical University.