Interpretation of Serum Hepatitis Markers in Patients and Donors Before HCT
| Patient Result . | Donor Result . | Interpretation . | Recommendation . |
|---|---|---|---|
| Hepatitis B Virus | |||
| Anti-HBs positive | Negative | Patient has had prior exposure to HBV or has been vaccinated | Proceed with transplantation |
| Negative | Anti-HBs positive | Donor has had prior exposure to HBV or has been vaccinated | Proceed with transplantation |
| Anti-HBc positive (HBsAg and anti-HBs negative) | Negative | Patient has had prior exposure to HBV and is at risk for viral reactivation after transplant | Test for HBV DNA by PCR from 2 weeks posttransplant; consider antiviral therapy if serum positive for HBV DNA. |
| Negative | Anti-HBc positive (HBsAg and anti-HBs negative) | Donor has had prior exposure to HBV | Test donor for HBV DNA by PCR; if the result is negative, there is a negligible risk of viral transmission. If positive, consider antiviral therapy. |
| HBsAg positive | Negative | Current HBV infection in patient | Assessment for liver disease in patient, as patients with cirrhosis have a high risk for fatal VOD. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| HBsAg positive | Anti-HBs ± anti-HBc positive | Current HBV infection in the patient. Donor has immunity to HBV. | Assessment for liver disease in patient, as patients with cirrhosis have a high risk for fatal VOD. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| HBsAg positive | HBsAg positive | Current HBV infection in the patient and the donor | Assessment for liver disease in recipient, as patients with cirrhosis have a high risk for fatal VOD. Assessment for liver disease in donor, as there is an anesthesia risk during marrow harvest if the donor has cirrhosis. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| Negative | HBsAg positive | Current HBV infection in the donor | Assessment for liver disease in donor, as there is an anesthesia risk during marrow harvest if the donor has cirrhosis. Consider an alternate donor. Consider antiviral treatment of donor before stem cell harvest. Monitor recipient HBV DNA levels posttransplant and consider antiviral therapy if patient develops viremia. |
| Hepatitis C Virus | |||
| Anti-HCV positive but HCV RNA negative | Negative | Patient has had passive acquisition of HCV antibody or has recovered from prior HCV infection or has a falsely negative HCV RNA | Repeat HCV RNA by a more sensitive method; check HCV RNA posttransplant. |
| HCV RNA positive | Negative | Current HCV infection in patient | Assessment for active liver disease or cirrhosis in patient before transplantation. Observe patient for development of chronic hepatitis after transplantation. Consider antiviral therapy in long-term follow-up. |
| Negative | HCV RNA positive | Current donor infection; HCV transmission is likely | Consider alternate donor; if this donor is the best available match, consider treatment of donor before marrow or stem cell harvest. |
| Patient Result . | Donor Result . | Interpretation . | Recommendation . |
|---|---|---|---|
| Hepatitis B Virus | |||
| Anti-HBs positive | Negative | Patient has had prior exposure to HBV or has been vaccinated | Proceed with transplantation |
| Negative | Anti-HBs positive | Donor has had prior exposure to HBV or has been vaccinated | Proceed with transplantation |
| Anti-HBc positive (HBsAg and anti-HBs negative) | Negative | Patient has had prior exposure to HBV and is at risk for viral reactivation after transplant | Test for HBV DNA by PCR from 2 weeks posttransplant; consider antiviral therapy if serum positive for HBV DNA. |
| Negative | Anti-HBc positive (HBsAg and anti-HBs negative) | Donor has had prior exposure to HBV | Test donor for HBV DNA by PCR; if the result is negative, there is a negligible risk of viral transmission. If positive, consider antiviral therapy. |
| HBsAg positive | Negative | Current HBV infection in patient | Assessment for liver disease in patient, as patients with cirrhosis have a high risk for fatal VOD. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| HBsAg positive | Anti-HBs ± anti-HBc positive | Current HBV infection in the patient. Donor has immunity to HBV. | Assessment for liver disease in patient, as patients with cirrhosis have a high risk for fatal VOD. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| HBsAg positive | HBsAg positive | Current HBV infection in the patient and the donor | Assessment for liver disease in recipient, as patients with cirrhosis have a high risk for fatal VOD. Assessment for liver disease in donor, as there is an anesthesia risk during marrow harvest if the donor has cirrhosis. If recipient is HBV DNA positive, institute antiviral therapy before transplant. If negative, monitor HBV DNA posttransplant and institute antiviral therapy if becomes positive. |
| Negative | HBsAg positive | Current HBV infection in the donor | Assessment for liver disease in donor, as there is an anesthesia risk during marrow harvest if the donor has cirrhosis. Consider an alternate donor. Consider antiviral treatment of donor before stem cell harvest. Monitor recipient HBV DNA levels posttransplant and consider antiviral therapy if patient develops viremia. |
| Hepatitis C Virus | |||
| Anti-HCV positive but HCV RNA negative | Negative | Patient has had passive acquisition of HCV antibody or has recovered from prior HCV infection or has a falsely negative HCV RNA | Repeat HCV RNA by a more sensitive method; check HCV RNA posttransplant. |
| HCV RNA positive | Negative | Current HCV infection in patient | Assessment for active liver disease or cirrhosis in patient before transplantation. Observe patient for development of chronic hepatitis after transplantation. Consider antiviral therapy in long-term follow-up. |
| Negative | HCV RNA positive | Current donor infection; HCV transmission is likely | Consider alternate donor; if this donor is the best available match, consider treatment of donor before marrow or stem cell harvest. |
Abbreviations: anti-HBs, antibody to hepatitis B surface antigen; anti-HBc, antibody to hepatitis B core antigen; HBsAg, hepatitis B surface antigen; anti-HCV, antibody to hepatitis C virus; VOD, venocclusive disease; PCR, polymerase chain reaction.