title: False-positive hepatitis C virus serology after placement of a ventricular assistance device.
abstract: BACKGROUND
  Ventricular assist devices (VADs) have been associated with immune activation and sensitization. We observed several cases of false-positive (FP) hepatitis C virus (HCV) antibody (Ab) tests in patients being evaluated for orthotopic heart transplant (OHT), prompting us to investigate this further.
  
  
  METHODS
  We reviewed all VAD and OHT cases at Johns Hopkins from 2005 to 2012. FP HCV serology was defined as an equivocal or low-positive HCV Ab, plus either (i) a negative recombinant immunoblot (RIBA) and/or HCV nucleic acid test (NAT), or (ii) an indeterminate RIBA and negative NAT.
  
  
  RESULTS
  In 53 patients with available HCV testing, nearly 40% of patients (21/53: 39.6%) developed FP HCV Ab tests after VAD placement: 4 patients had negative NAT, 12 had negative RIBA, and 5 had an indeterminate RIBA and negative NAT. All patients with indeterminate RIBA tests had isolated reactivity to the same HCV protein, c100p/5-1-1p (NS4b protein). In 3 of 4 VAD patients who had OHT and repeat HCV Ab testing after VAD removal, repeat HCV Ab was negative (699-947 days after OHT); in 1 case, FP HCV serology persisted (5 days after OHT). Thirteen patients had OHT alone and none developed a FP HCV Ab.
  
  
  CONCLUSIONS
  FP HCV Ab results following VAD placement are very common. Reversal of FP serology in several patients after VAD removal is suggestive of a possible association with the VAD hardware. Clinicians should be aware of this phenomenon, as it could lead to delays in determining eligibility for OHT and increased costs.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.|The Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Durand
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.|The Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Marr
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: D
authors.initials: D
authors.lastname: Ostrander
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Subramanian
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Valsamakis
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cox
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: D
authors.initials: D
authors.lastname: Neofytos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D006353:Heart-Assist Devices / Q000821:virology; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral
keywords: false-positive hepatitis C virus serology; left ventricular assist device; orthotopic heart transplant; panel reactive antibodies; sensitization