title: Hepatitis E seroprevalence in recipients of renal transplants or haemodialysis in southwest England: a case-control study.
abstract: Locally acquired HEV infection is increasingly recognized in developed countries. Anti-HEV IgG seroprevalence has been shown to be high in haemodialysis patients in a number of previous studies, employing assays of uncertain sensitivity. The aim of this study was to investigate anti-HEV IgG seroprevalence in recipients of haemodialysis and renal transplants compared to a control group using a validated, highly sensitive assay. Eighty-eight patients with functioning renal transplants and 76 receiving chronic haemodialysis were tested for HEV RNA and anti-HEV IgG and IgM. Six hundred seventy controls were tested for anti-HEV IgG. Anti-HEV IgG was positive in 28/76 (36.8%) of haemodialysis and 16/88 (18.2%) of transplant patients. HEV RNA was not found in any patient. 126/670 (18.8%) of control subjects were anti-HEV IgG positive. After adjusting for age and sex, there was a significantly higher anti-HEV IgG seroprevalence amongst haemodialysis patients compared to controls (OR = 1.97, 95% CI = 1.16-3.31, P = 0.01) or transplant recipients (OR = 2.63, 95% CI = 1.18-6.07, P = 0.02). Patients with a functioning transplant showed no difference in anti-HEV IgG seroprevalence compared to controls. The duration of haemodialysis or receipt of blood products were not significant risk factors for HEV IgG positivity. Patients receiving haemodialysis have a higher seroprevalence of anti-HEV IgG than both age- and sex-matched controls and a cohort of renal transplant patients. None of the haemodialysis patients had evidence of chronic infection. The reason haemodialysis patients have a high seroprevalence remains uncertain and merits further study.
authors.affiliation: Department of Nephrology, Royal Cornwall Hospital Truro, Cornwall, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Harrison
authors.forename: Linda
authors.initials: L
authors.lastname: Scobie
authors.forename: Claire
authors.initials: C
authors.lastname: Crossan
authors.forename: Rob
authors.initials: R
authors.lastname: Parry
authors.forename: Paul
authors.initials: P
authors.lastname: Johnston
authors.forename: Jon
authors.initials: J
authors.lastname: Stratton
authors.forename: Steve
authors.initials: S
authors.lastname: Dickinson
authors.forename: Vic
authors.initials: V
authors.lastname: Ellis
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Prescott
authors.forename: Richie
authors.initials: R
authors.lastname: Madden
authors.forename: Nan X
authors.initials: NX
authors.lastname: Lin
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bendall
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014180:Transplantation; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral