Loss of Anti-Hepatitis E Virus Antibodies in Organ Transplant Patients with Hepatitis E

Abstract

Background: To date, no reports exist regarding changes in anti-hepatitis E virus (HEV) antibodies after HEV infection in organ transplant patients. We followed up participants in a previously reported “Japanese national survey of Hepatitis E in liver, heart, and kidney transplant patients” from 2012 to 2017, to clarify HEV infection trends. Methods: Data on 106 transplant patients that were included in the current study; 32 liver, seven heart, and 67 kidney transplant recipients in 16 institutes in Japan were examined for immunoglobulin G (IgG), IgM, IgA classes of anti-HEV antibodies, and HEV RNA in the serum. Two, one, and five liver, heart, and kidney transplant patients, respectively, in whose serum HEV RNA was identified were examined. Furthermore, 30, six, and 62 liver, heart, and kidney transplant patients, respectively, positive for anti-IgG-HEV antibody were also examined. In each patient, HEV RNA, anti-HEV IgA antibody, anti-HEV IgM antibody, and anti-HEV IgG antibody titres were measured. Findings: Of eight patients with hepatitis E who were positive for HEV RNA, one (14·0%) had anti-IgG-HEV antibody negative conversion. Contrariwise, of 98 patients that were negative for HEV RNA, 24 (24·5%) had anti-HEV IgG antibody negative conversion. Of 24 patients, eight, 12, and four were liver, kidney, and heart transplant patients, respectively. Interpretation: Anti-HEV IgG antibody loss may occur unexpectedly with high frequency in transplanted patients with past HEV infection. Therefore, the possibility of HEV re-infection in transplanted patients exists, and care should be taken to prevent this. Funding: This research was supported by AMED (Grant Number JP19fk0210043). Declaration of Interests: None declared. Ethical Approval Statement: The date of birth, sex, date of transplantation, and number of immunosuppressant were extracted from the medical records. This research was approved by the Ethics Committee at our centre and at each patient's institution (IB1811). All the recipients gave written informed consent to participate in this study.