Clinical significance of post-liver transplant hepatitis E seropositivity in high prevalence area of hepatitis E genotype 3: a prospective study

Abstract

High hepatitis E (HEV) seroprevalence has been reported in the general population and in post-liver transplant (LT) cases in several regions, including Thailand, with genotype 3 being a predominant genotype. We hypothesized that HEV might persist at a subclinical level and might pose clinical risks in the post-LT period. We performed a cross-sectional study with 108 post-LT patients and found an IgG seroprevalence of 55.6%. Subsequently, 91 cases without clinical evidence of HEV-related hepatitis were enrolled in 1 year of prospective follow-up to determine clinical status, serologies and serum/feces HEV RNA every 4 months. HEV RNA was detected, indicating subclinical infections in patients with or without seropositivity, with an annual incidence of 7.7%. Our results suggest that subclinical HEV infection exists among LT patients in this high-prevalence area. Thus, clinicians should be aware of the possibility of disease reemergence and HEV viral transmission in LT patients.

Molecular Characterization and Seroprevalence of Hepatitis E Virus in Inflammatory Bowel Disease Patients and Solid Organ Transplant Recipients

“…The results presented here demonstrate a significantly higher risk of anti-HEV IgG presence among IBD patients and SOT recipients, compared to the healthy sample group. This is consistent with findings reporting increased risk of HEV infection among liver allograft recipients and increased risk of opportunistic pathogens in immunosuppressed individuals [ 11 , 13 ]. A substantial amount of research has been carried out investigating the relationship between IBD and different viral hepatitis forms (mainly HBV and HCV).…”

“…Among the immunosuppressed individuals, blood transfusion and solid organ transplant (SOT) recipients, and especially liver allograft recipients, have been recognized as risk groups for the development of chronic HEV-3 [ 12 , 13 ]. In a recent study, an HEV-3 seroprevalence rate of 55.6% was observed in liver allograft recipients, with an active hepatitis rate of 2.8% [ 13 ]. This is a significantly higher HEV-3 seroprevalence rate compared to the general population, where anti-HEV antibody-positive individual rates range from 0.1% to 12% on average [ 14 ].…”

Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

“…Frequencies were presented in numbers and percentages. GA (gestational age), AST (aspartate aminotransferase enzyme), ALT (alanine aminotransferase enzyme), ALP (alkaline phosphatase enzyme), TB (total bilirubin), ATV/r (atazanavir/ritonavir), HT (hypertension), UGIB (upper gastrointestinal bleeding), HELLP (hemolysis, elevated liver enzymes, and low platelet count), DFIU (dead fetus in utero), HAV (hepatitis A virus), HBV (hepatitis B virus), HEV (hepatitis E virus) as 55.6% by Kamolmit et al [15]. In concordance to our study, anti-HEV IgG antibodies were detected in 42.3% of the transplant group, with the highest prevalence in kidney transplant recipients (50%).…”

Epidemiology and treatment of hepatitis E in the liver transplantation setting: A literature review

“…The percentage of male LT recipients in the cohorts ranged from 51.2% to 83.3% 9,10,13–19,21,23,24 . At the time of evaluation (ranging from 3 to 107 months post‐LT) 9,10,15,16,19,21,23,24 the mean/median values of AST, ALT and bilirubin were from 24 to 59 IU/L, 10,15,16,24 19 to 71 IU/L 10,11,13,15,16,24 and 4 to 36 μmol/L, 10,11,15,16,24 respectively. Based on the available data, 34 of the 5227 LT recipients tested for HEV RNA had confirmed HEV infection at 5.5 to 96 months post‐LT 10,15,16,18,20,21 having mean/median AST, ALT and bilirubin levels from 29.5 to 250 IU/L, 15,16,18 22.8 to 250 IU/L 15,16,18,20,24 and 10.3 to 198 μmol/L, 15,16,18,20 respectively.…”

“…Among the six studies published between 2009 and 2014, 9–14 only three evaluated HEV RNA (with 9,10 or without 12 HEV Abs) including 820 (53%) recipients. In contrast, all the studies published between 2015 and 2020, 15–24 evaluated HEV RNA (with 16,17,19,23,24 or without HEV Abs 15,18,20–22 ). The seroprevalence of anti‐HEV IgG ranged from 3.16% to 27.7% and 2.9% to 53.3% (24.4% in the only European cohort reporting IgG) between 2009 and 2014 and between 2015 and 2020, respectively.…”