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.
Highlights
It has been a decade since the emergence of evidence of the ability of hepatitis E virus (HEV) to cause chronic hepatitis and cirrhosis in immunocompromised hosts, including HIV and solid organ transplant (SOT) patients, and especially in liver transplant (LT) recipients[1,2]
It is challenging to determine the extent of the problem of diseases associated with HEV genotype 3 in the SOT population, whether the patients with IgG positivity can clear the virus, whether the patients without IgG seropositivity remain at risk without specific RNA testing, and what are the clinical courses of the patients who are positive for HEV RNA
Of the 108 post-LT patients evaluated for HEV seroprevalence, 60 (55.6%) were seropositive [HEV IgG (+)], and 48 (44.4%) were seronegative [HEV IgG (−)] (Fig. 1)
Summary
It has been a decade since the emergence of evidence of the ability of hepatitis E virus (HEV) to cause chronic hepatitis and cirrhosis in immunocompromised hosts, including HIV and solid organ transplant (SOT) patients, and especially in liver transplant (LT) recipients[1,2]. Thailand has genotype 3 as a common genotype, unlike other neighboring countries in Southeast Asia, India and China[5] This gives unique insight into the hidden problems in SOT recipients that have never been explored. The HEV IgG seroprevalence in SOT and LT recipients has been reported in several studies in Europe and North America, varying from 3–28%, with a serum RNA detection rate of 0–2%, and the incidence of chronic hepatitis E is up to 3%10. It is challenging to determine the extent of the problem of diseases associated with HEV genotype 3 in the SOT population, whether the patients with IgG positivity can clear the virus, whether the patients without IgG seropositivity remain at risk without specific RNA testing, and what are the clinical courses of the patients who are positive for HEV RNA. The patients were prospectively followed for 12 months, and the clinical changes, liver function tests, serum HEV serology and RNA, and stool HEV RNA were assessed
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