Hepatitis E prevalence and infection in solid-organ transplant recipients in the United States
Corresponding Author
Niharika Samala
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Correspondence
Niharika Samala, 702 Rotary Circle, Indianapolis, IN, 46202, USA.
Email: [email protected]
Search for more papers by this authorRichard Y. Wang
Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorSungyoung Auh
Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorAbdalla Kara Balla
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Search for more papers by this authorLara Dakhoul
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Search for more papers by this authorHarvey J. Alter
Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorPatrizia Farci
Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorMarwan Ghabril
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Search for more papers by this authorMichael R. Lucey
Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Search for more papers by this authorAmol S. Rangnekar
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Search for more papers by this authorK. Rajender Reddy
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMarc G. Ghany
Liver Disease Branch (LDB), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorCorresponding Author
Niharika Samala
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Correspondence
Niharika Samala, 702 Rotary Circle, Indianapolis, IN, 46202, USA.
Email: [email protected]
Search for more papers by this authorRichard Y. Wang
Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorSungyoung Auh
Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorAbdalla Kara Balla
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Search for more papers by this authorLara Dakhoul
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Search for more papers by this authorHarvey J. Alter
Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorPatrizia Farci
Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorMarwan Ghabril
Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA
Search for more papers by this authorMichael R. Lucey
Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Search for more papers by this authorAmol S. Rangnekar
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Search for more papers by this authorK. Rajender Reddy
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorMarc G. Ghany
Liver Disease Branch (LDB), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Search for more papers by this authorAbstract
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide. An increased risk for HEV infection has been reported in organ-transplant recipients, mainly from Europe. Prospective data on HEV prevalence in the United States (U.S.) organ transplant population are limited. To determine the prevalence and factors associated with HEV infection among solid organ transplant-recipients, we conducted a prospective, cross-sectional, multicentre study among transplant-recipients and age- and organ-matched waitlist patients. Participants answered a risk-exposure questionnaire and were tested for HEV-RNA (in-house PCR), HEV-IgG, and IgM (ELISA, Wantai). Among 456 participants, 224 were transplant-recipients, and 232 were waitlist patients. The mean age was 58 years, 35% female, and 74% White. HEV seroprevalence of the entire cohort was 20.2% and associated with older age (p < 0.0001) and organ transplantation (p = 0.02). The HEV seropositivity was significantly higher among transplant-recipients compared with waitlist patients (24% vs. 16.4%, p = 0.042). Among transplant recipients, relative-risk of being HEV seropositive increased with older age (RR = 3.4 [1.07–10.74] in patients >70 years compared with ≤50 years, p = 0.037); history of graft hepatitis (2.2 [1.27–3.72], p = 0.005); calcineurin inhibitor use (RR = 1.9 [1.03–3.34], p = 0.02); and kidney transplantation (2.4 [1.15–5.16], p = 0.02). HEV-RNA, genotype 3 was detected in only two patients (0.4%), both transplant-recipients. HEV seroprevalence was higher among transplant-recipients than waitlist patients. HEV should be considered in transplant-recipients presenting with graft hepatitis. Detection of HEV-RNA was rare, suggesting that progression to chronic HEV infection is uncommon in transplant-recipients in the U.S.
CONFLICT OF INTEREST
The authors of this manuscript have no conflicts of interest to disclosure pertinent to the study.
Open Research
DATA AVAILABILITY STATEMENT
The datasets generated during the current study are not publicly available due to presence of protected health information, but de-identified data are available from the corresponding author on reasonable request.
Supporting Information
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Appendix S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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