The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study

Overview

Journal Viruses

Publisher MDPI

Specialty Microbiology

Date 2024 Feb 24

PMID 38400077

Authors

Michelle Zicker

Joao R R Pinho

Eliane A R Welter

Bianca D Guardia

Paulo G T M da Silva

Leonardo B da Silveira

Luis F A Camargo

Affiliations

Soon will be listed here.

Abstract

The hepatitis E virus is a major etiological agent of chronic hepatitis in immunosuppressed individuals. Seroprevalence in the liver transplantation setting varies according to the seroprevalence of the general population in different countries. This was a prospective cohort study of liver transplant recipients in southeastern Brazil. Recipients were systematically followed for one year, with the objective of determining the prevalence, incidence, and natural history of HEV infection in this population. We included 107 liver transplant recipients and 83 deceased donors. Positivity for anti-HEV IgG was detected in 10.2% of the recipients and in 9.7% of the donors. None of the patients tested positive for HEV RNA at baseline or during follow-up. There were no episodes of reactivation or seroconversion, even in cases of serological donor-recipient mismatch or in recipients with acute hepatitis. Acute and chronic HEV infections seem to be rare events in the region studied. That could be attributable to social, economic, and environmental factors. Our data indicate that, among liver transplant recipients, hepatitis E should be investigated only when there are elevated levels of transaminases with no defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation.

References

le Coutre P, Meisel H, Hofmann J, Rocken C, Vuong G, Neuburger S . Reactivation of hepatitis E infection in a patient with acute lymphoblastic leukaemia after allogeneic stem cell transplantation. Gut. 2009; 58(5):699-702. DOI: 10.1136/gut.2008.165571. View

Kamar N, Garrouste C, Haagsma E, Garrigue V, Pischke S, Chauvet C . Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology. 2011; 140(5):1481-9. DOI: 10.1053/j.gastro.2011.02.050. View

Li P, Liu J, Li Y, Su J, Ma Z, Bramer W . The global epidemiology of hepatitis E virus infection: A systematic review and meta-analysis. Liver Int. 2020; 40(7):1516-1528. PMC: 7384095. DOI: 10.1111/liv.14468. View

Buffaz C, Scholtes C, Dron A, Chevallier-Queyron P, Ritter J, Andre P . Hepatitis E in liver transplant recipients in the Rhône-Alpes region in France. Eur J Clin Microbiol Infect Dis. 2014; 33(6):1037-43. DOI: 10.1007/s10096-013-2042-2. View

Buti M, Cabrera C, Jardi R, Castells L, Esteban R . Are recipients of solid organ transplantation a high-risk population for hepatitis E virus infection?. Liver Transpl. 2009; 16(1):106-7. DOI: 10.1002/lt.21925. View

Legrand-Abravanel F, Kamar N, Sandres-Saune K, Lhomme S, Mansuy J, Muscari F . Hepatitis E virus infection without reactivation in solid-organ transplant recipients, France. Emerg Infect Dis. 2011; 17(1):30-7. PMC: 3298369. DOI: 10.3201/eid1701.100527. View

Nishizawa T, Takahashi M, Tsatsralt-Od B, Nyamdavaa K, Dulmaa N, Osorjin B . Identification and a full genome analysis of novel camel hepatitis E virus strains obtained from Bactrian camels in Mongolia. Virus Res. 2021; 299:198355. DOI: 10.1016/j.virusres.2021.198355. View

Huang W, Zhang H, Harrison T, Lang S, Huang G, Wang Y . Cross-protection of hepatitis E virus genotypes 1 and 4 in rhesus macaques. J Med Virol. 2008; 80(5):824-32. DOI: 10.1002/jmv.21140. View

Stroffolini T, Rapicetta M, Chionne P, Esvan R, Madonna E, Lombardo F . Evidence for the presence of autochthonous (locally acquired) cases of acute hepatitis E virus infections in Italy since the 80s. Eur J Intern Med. 2015; 26(5):348-50. DOI: 10.1016/j.ejim.2015.03.012. View

10.

Pas S, de Man R, Mulders C, Balk A, van Hal P, Weimar W . Hepatitis E virus infection among solid organ transplant recipients, the Netherlands. Emerg Infect Dis. 2012; 18(5):869-72. PMC: 3358074. DOI: 10.3201/eid1805.111712. View

11.

Tengan F, Figueiredo G, Nunes A, Manchiero C, Dantas B, Magri M . Seroprevalence of hepatitis E in adults in Brazil: a systematic review and meta-analysis. Infect Dis Poverty. 2019; 8(1):3. PMC: 6334402. DOI: 10.1186/s40249-018-0514-4. View

12.

Conte D, de Souza Luna L, Passarini A, Alves V, Caldeira D, Cruz J . Hepatitis E virus infection among patients with altered levels of alanine aminotransferase. Braz J Infect Dis. 2021; 25(6):101655. PMC: 9392201. DOI: 10.1016/j.bjid.2021.101655. View

13.

Haagsma E, Niesters H, van den Berg A, Riezebos-Brilman A, Porte R, Vennema H . Prevalence of hepatitis E virus infection in liver transplant recipients. Liver Transpl. 2009; 15(10):1225-8. DOI: 10.1002/lt.21819. View

14.

Dos Santos D, Lewis-Ximenez L, da Silva M, De Sousa P, Gaspar A, Pinto M . First report of a human autochthonous hepatitis E virus infection in Brazil. J Clin Virol. 2010; 47(3):276-9. DOI: 10.1016/j.jcv.2009.12.021. View

15.

Riveiro-Barciela M, Buti M, Homs M, Campos-Varela I, Cantarell C, Crespo M . Cirrhosis, liver transplantation and HIV infection are risk factors associated with hepatitis E virus infection. PLoS One. 2014; 9(7):e103028. PMC: 4113416. DOI: 10.1371/journal.pone.0103028. View

16.

Sinakos E, Gioula G, Liava C, Papa A, Papadopoulou E, Tsakni E . Prevalence of hepatitis E in liver transplant recipients in Greece. Epidemiol Infect. 2018; 146(13):1619-1621. PMC: 9507950. DOI: 10.1017/S0950268818001887. View

17.

Schlosser B, Stein A, Neuhaus R, Pahl S, Ramez B, Kruger D . Liver transplant from a donor with occult HEV infection induced chronic hepatitis and cirrhosis in the recipient. J Hepatol. 2011; 56(2):500-2. DOI: 10.1016/j.jhep.2011.06.021. View

18.

Reekie I, Irish D, Ijaz S, Fox T, Bharucha T, Griffiths P . Hepatitis E infection in stem cell and solid organ transplantpatients: A cross-sectional study: The importance of HEV RNA screening in peri-transplant period. J Clin Virol. 2018; 107:1-5. DOI: 10.1016/j.jcv.2018.07.011. View

19.

Kamar N, Pischke S . Acute and Persistent Hepatitis E Virus Genotype 3 and 4 Infection: Clinical Features, Pathogenesis, and Treatment. Cold Spring Harb Perspect Med. 2018; 9(7). PMC: 6601456. DOI: 10.1101/cshperspect.a031872. View

20.

Chorami M, Bagheri Lankarani K, Ejtehadi F, Malek-Hosseini S, Moini M . Hepatitis E Virus Seroprevalence Among Liver Transplant Recipients with Persistent Elevation of Liver Enzymes: A Single Center Report. Arch Iran Med. 2021; 24(1):22-26. DOI: 10.34172/aim.2021.04. View