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Hepatitis E Virus Infection in Kidney Transplant Patients

A Single-Center Study

Lim, Mary A. MD1; Kamili, Saleem PhD2; Cohen, Jordana B. MD, MSCE1,3; Green-Montfort, Tracy BS2; Tejada-Strop, Alexandra MS2; Kohli, Jatinder MD1; Drobeniuc, Jan MD, PhD2; Patel, Priyanka MS1; Vanderveen, Mary BS1; Bloom, Roy D. MD1

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doi: 10.1097/TP.0000000000002071
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Hepatitis E virus (HEV) infection has a prevalence rate of 6-10% in the US population.1 Though widely studied in European kidney recipients,2,3 little is known about the prevalence and impact of HEV infection in US kidney transplant patients. This prospective, observational single-center study conducted between 2/1/2014 and 1/31/2015 evaluated HEV risk factors, and anti-HEV IgM, IgG, and HEV RNA in 244 kidney candidates, 104 of whom were transplanted during the study period (Figure 1). Among candidates, the anti-HEV IgG prevalence was 18% (n = 44) and increased with age (P = 0.004). Among recipients, the prevalence increased from 19% pre to 26% posttransplant (P = 0.015), although HEV RNA remained undetectable. In multivariable mixed-effects logistic regression analysis, HEV seroconversion was associated with diabetes and concomitant BK virus and cytomegalovirus infection, suggesting an association between HEV infection and degree of immunosuppression (Table 1). Rejection rates and 2-year graft survival were similar between HEV seroconverters and nonseroconverters. Among eight seronegative patients who received kidneys from aviremic, HEV-seropositive donors, none had evidence of HEV infection on follow-up. In conclusion, the prevalence of HEV infection in kidney candidates is higher than reported in the general population, and increases with age and during the first posttransplant year. Contrary to previous reports, we found that although reduced immune status may predispose recipients to HEV infection, infections are largely asymptomatic and appeared to resolve spontaneously.

FIGURE 1
FIGURE 1:
Study design and recruitment of patients from office visits for transplant evaluation and hospital admission for kidney transplantation. Transplanted patients were followed for an additional 6-12 months posttransplant.
TABLE 1
TABLE 1:
Multivariable mixed-effects logistic regression analysis of potential risk factors for anti-HEV seroconversion in kidney transplant recipientsa

The findings and conclusions herein are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

REFERENCES

1. Teshale EH, Maxine MD, Drobeniuc J, et al. Decline in hepatitis E virus antibody prevalence in the United States from 1988–1994 to 2009–2010. J Infect Dis 211:366–373, 2015.
2. Kamar N, Garrouste C, Haagsma EB, et al. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology. 2011;140:1481–1489.
3. Pischke S, Stiefel P, Franz B, et al. Chronic hepatitis E in heart transplant recipients. Am J Transplant. 2012;12:3128–3133.
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