A 75-year-old male patient returned to our centre for peritoneal dialysis after transplantectomy due to renal transplant rejection. Routine viral screening prior to resuming dialysis indicated anti-Hepatitis B (anti-HB titre of 363 IU/L [anti-Hepatitis Bcore (anti-HBc) and Hepatitis Be antigen (HBeAg) both negative], which suggested that the patient received hepatitis B vaccination. However, both patient and the referring centre denied vaccination. The patient’s anti-HB titres decreased over time (Table 1).
Table 1.
Course of anti-HB titres and relevant events
| Date | Event | Anti-HB titres (IU/L) |
|---|---|---|
| June 2017 | Dialysis | <3, 10 |
| October 2018 | IVIG therapy | |
| October 2018 | Transplantectomy | |
| 5 November 2018 | Blood test | 363 |
| 29 November 2018 | Blood test | 195 |
| 13 December 2018 | Blood test | 101 |
During anti-rejection therapy, the patient received intravenous immunoglobulin (IVIG) therapy. The possibility of passive transfer of hepatitis B antibodies after IVIG administration resulting in false-positive hepatitis B serology and partial passive immunization following IVIG has been described [1–4].
Attention to the possibility of this passive immunization is important, as it can lead to misinterpretation of test results with implications for further treatment. This phenomenon may be more prevalent with the increased use of IVIG in transplant rejection nowadays.
CONFLICT OF INTEREST STATEMENT
None declared.
REFERENCES
- 1. Arnold DM, Crowther MA, Meyer RM. et al. Misleading hepatitis B test results due to intravenous immunoglobulin administration: implications for a clinical trial of rituximab in immune thrombocytopenia. Transfusion 2010; 50: 2577–2581 [DOI] [PubMed] [Google Scholar]
- 2. Lee S, Kim HW, Kim K-H.. Antibodies against Hepatitis A and Hepatitis B virus in intravenous immunoglobulin products. J Korean Med Sci 2016; 31: 1937–1942 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Parker S, Gil E, Hewitt P. et al. Case report: passive transfer of hepatitis B antibodies from intravenous immunoglobulin. BMC Infect Dis 2014; 14: 99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Benton E, Iqbal K, Wade P. et al. False-positive Hepatitis B serology following IVIG therapy: forgotten but not gone!! J Am Acad Dermatol 2012: e123–124 [DOI] [PubMed] [Google Scholar]