Abstract
IntroductionHepatitis E virus (HEV) can cause chronic infection (≥3 months) and cirrhosis in immunocompromised patients, especially kidney transplant recipients. Low ALT levels and high HEV intra-host diversity have previously been associated with evolution toward chronicity in these patients. We hypothesized that additional clinical and viral factors could be associated with the risk of chronic HEV infection. MethodsWe investigated a series of 27 kidney transplant recipients with HEV infection, including 20 patients with chronic hepatitis E. ResultsHigh tacrolimus trough concentration at diagnosis was the most relevant marker associated with chronic hepatitis E (9.2 vs 6.4 ng/mL, p = 0.04). Most HEV genetic changes selected during HEV infection were compartmentalized between plasma and feces. DiscussionThis compartmentalization highlights the diversity and complexity of HEV replication compartments. Tacrolimus trough concentration at diagnosis of HEV infection could allow an early identification of patients at high risk of chronic hepatitis E and guide treatment initiation.
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