Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis

Abstract

BACKGROUND Hepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death. AIM To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients. METHODS We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay. RESULTS Of 563 citations, a total of 22 studies ( n = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: liver (27.2%; 95%CI: 20.0-35.8), kidney (12.8%; 95%CI: 9.3-17.3), heart (12.8%; 95%CI: 9.3-17.3), and lung (5.6%; 95%CI: 1.6-17.9). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, P = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4). CONCLUSION HEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.

Hepatitis E virus Infection in Hematopoietic Stem Cell Transplant Recipients: A Systematic Review and Meta-Analysis

“…We recently reported the prevalence of HEV infection in solid organ transplant recipients 23. Thus, the search strategy in the current study was similar to our recent publication.…”

“…22 A recent meta-analysis showed that the prevalence of HEV infection was highest in liver transplant and lowest in lung transplant. 23 Subgroup analyses also showed that the prevalence of HEV infection was significantly higher in middle-income countries compared with high-income countries. However, data on HEV infection in HSCT recipients are limited.…”

“…HEV infection has been reported to cause graft cirrhosis and liver failure in liver transplant recipients 22. A recent meta-analysis showed that the prevalence of HEV infection was highest in liver transplant and lowest in lung transplant 23. Subgroup analyses also showed that the prevalence of HEV infection was significantly higher in middle-income countries compared with high-income countries.…”

Hepatitis E Virus Infection—Immune Responses to an Underestimated Global Threat

“…Due to a rather strong therapeutical immunosuppression to prevent rejection, SOT patients can develop several opportunistic infections. A recent meta-analysis [ 139 ] found that HEV prevalence in SOT patients is about 20%. This involved first of all liver transplant recipients.…”

Porcine cytomegalovirus in xenotransplantation: The new frontier in human transplantation?

“…As we know, do zoonotic viruses infect humans such as HEV [19,20], for example, consuming undercooked meat. In general, harmless to humans, it might cause Hepatitis and there are only a few reports on severe courses of the disease, unless you are a recipient of an organ transplant under immunosuppression, under these circumstances, courses can become ugly and might end in organ failure [21]. As a matter of fact, undercooked meat or ground meat from pork is consumed, for example, in Germany, it is called "Mettbrötchen" and widely appreciated, at least in Germany.…”