A Nationwide Survey of Hepatitis E Virus Infection and Chronic Hepatitis E in Liver Transplant Recipients in Japan

Abstract

BackgroundRecently, chronic hepatitis E has been increasingly reported in organ transplant recipients in European countries. In Japan, the prevalence of hepatitis E virus (HEV) infection after transplantation remains unclear, so we conducted a nationwide cross-sectional study to clarify the prevalence of chronic HEV infection in Japanese liver transplant recipients.MethodsA total of 1893 liver transplant recipients in 17 university hospitals in Japan were examined for the presence of immunoglobulin G (IgG), IgM and IgA classes of anti-HEV antibodies, and HEV RNA in serum.FindingsThe prevalence of anti-HEV IgG, IgM and IgA class antibodies was 2.9% (54/1893), 0.05% (1/1893) and 0% (0/1893), respectively. Of 1651 patients tested for HEV RNA, two patients (0.12%) were found to be positive and developed chronic infection after liver transplantation. In both cases, HEV RNA was also detected in one of the blood products transfused at the perioperative period. Analysis of the HEV genomes revealed that the HEV isolates obtained from the recipients and the transfused blood products were identical in both cases, indicating transfusion-transmitted HEV infection.InterpretationThe prevalence of HEV antibodies in liver transplant recipients was 2.9%, which is low compared with the healthy population in Japan and with organ transplant recipients in European countries; however, the present study found, for the first time, two Japanese patients with chronic HEV infection that was acquired via blood transfusion during or after liver transplantation.

Prevalence and characteristics of hepatitis E virus infection in kidney transplant recipients: A single‐center experience in Japan

“…However, the routes of HEV transmission in our individual patients with anti‐HEV IgG positive were not uncovered in this cross‐sectional study. In immunosuppressed patients, HEV is transmitted via both the classical routes, namely fecal and/or oral route as well as the consumption of undercooked meat similarly as the general population, and other modes of transmission via liver graft, renal graft, blood transfusion, and hemodialysis unit as nosocomial infections . Although organ transplant recipients are exposed to various HEV infection routes, no kidney transplant recipients experienced symptomatic hepatitis due to HEV in our cohort.…”

“…Conversely, many cases of HEV infection have been reported from endemic regions such as Toulouse, France. In Japan, we identified a low prevalence of anti‐HEV immunoglobulin (Ig)G (2.9%) and HEV RNA (0.12%) in liver transplant recipients via a national survey . Meanwhile, the status and prognosis of HEV infection in kidney transplant recipients remain unknown.…”

Hepatitis E in Singapore: A Case-Series and Viral Phylodynamics Study

“…[9][10][11][12][13][14][15][16][17][18][19][20] It bears characteristics resembling hepatitis E that is indigenous to Europe and the United States, that is, higher clinical attack rates in older rather than young adults, and excess case-fatality rates among elderly men and women but not pregnant women. 1 Although in the west chronic HEV infection also has been found among SOTRs, 2 up to recently 3,30 it is unknown if this phenomenon extends to SOTRs in Asia. Prompted by findings from our first SOTR patient, 21 we have identified seven more SOTRs with hepatitis E (Table 1).…”

Patterns of mutation within an emerging endemic lineage of HEV‐3a

“…In most symptomatic patients with no underlying conditions, an HEV infection resembles typical acute viral hepatitis and usually resolves spontaneously . However, in immunocompromised patients, HEV can cause chronic infections that last longer than 3 months . An understanding of the viral mutations that arise in patients with an impaired or weakened immune response may yield insights into fundamental viral mutational patterns and biases, as well as the rate of turnover in dominant viral sequence.…”