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The clinical significance of occult hepatitis B transfusion in Taiwan – a look-back study


Dr Chun-Jen Liu, Assoc. Prof., Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 10002, Taiwan.
Tel.: 886-2-23123456 ext. 67503; fax: 886-2-23825962;


Objectives: A look-back study was conducted to determine the clinical significance of occult hepatitis B virus (HBV) blood transfusion in an HBV hyperendemic area.

Aim: To improve the blood transfusion safety.

Background: Occult HBV is transmissible through blood transfusion in HBV-naÏve recipients. However, its impact on recipients with prevalent HBV infection in HBV hyperendemic areas is unclear.

Methods/Materials: In 2006, 12 occult HBV blood donors were found from 10 824 repository samples by nucleic acid testing. The 74 corresponding recipients were identified and their pre- and post-transfusion clinical information was gathered, and the living recipients were recalled for follow-up. From the available archival sera, the HBV DNA was examined and sub-genomic sequences between paired donor and recipient were compared using polymerase chain reaction-based assays.

Results: Among the 74 recipients, 18 were still alive and 12 returned to our clinic. From the available serological profiles, 76% of recipients had ongoing or recovered HBV infection before transfusion. Only 24 recipients had available post-transfusion serological profiles and none seroconverted to be hepatitis B surface antigen (HBsAg) positive. Moreover, except for the prior HBsAg carriers, the recipients' HBV DNA levels after transfusion were low (<20 IU/mL). One recipient had identical HBV surface gene sub-genomic sequence (384 nucleotides) to his donor. After transfusion, no recipient developed post-transfusion hepatitis (PTH) and the clinical outcome was good.

Conclusion: In HBV hyperendemic areas, occult hepatitis B transfusion might not lead to HBsAg carriage or PTH. The risk of transfusion-transmitted HBV infection was probably lower than that in non-endemic areas because most recipients had already experienced HBV infection.