Low Risk of HBV Breakthrough Infection in Immunosuppressive Children with HBcAb-Positive Blood Transfusion: Retrospective and Prospective Studies

Background & Aims: Immunosuppressive adults with occult hepatitis B can experience HBV reactivation. Blood transfusion was common in acute lymphoblastic leukemia (ALL) children with immunosuppressive therapy, in which may inevitable with hepatitis B core antibody (HBcAb)-positive blood components. This study aims to evaluate the risk of HBV breakthrough infection in immunosuppressive children with HBcAb-positive blood components transfusion. Method: Cohort study was conducted in ALL children receiving blood components infusion during immunosuppressive therapy from Sep, 2012 to June, 2019. Eligible children were hepatitis B surface antigen (HBsAg) and HBcAb-negative pre-transfusion. The main outcome was HBV breakthrough infection with detectable HBsAg or HBV DNA in children during chemotherapy. Findings: HBV infection was identified in 0.98% (4/410) of children during chemotherapy. Significant difference existed in the percentage of HBcAb-positive at pre-transfusion, 2 and 10 month post-transfusion (6.3% vs. 37.7% vs. 0.67% , p <0.05), at which time same changes were also found in the HBsAb levels, and especially prominent in group II children with detectable HBcAb (p <0.05). Eleven patients have been prospective follow-up, 66.7% of patients had detectable HBV DNA at HBcAb seroreversion post-transfusion, but no HBV infection was detected during the recent follow-up. Interpretation: Low risk of HBV breakthrough infection in immunosuppressive children with HBcAb-positive blood conponents infusion. Occult hepatitis B in children with a family history of HBV infection should be taken more attention. Passive transfer of HBV antibody in children after blood components infusion was transient, and notably, low level of HBsAb in cancer children after immunosuppressive therapy is needed to take seriously. Further trials with larger cohorts are needed to verify our findings. Trial Registration: (ClinicalTrials.gov identifier NCT-03529760) Funding Statement: National Natural Science Foundation of China (No.81371876), Health and Family Planning Commission of Chongqing [2013] 39-2013-1-025, Chongqing Municipal Colleges and Universities Outstanding Talent Support Program. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Ethics Review Committee of Children’s Hospital of Chongqing Medical University.