title: Hepatitis E virus reinfections in solid-organ-transplant recipients can evolve into chronic infections.
abstract: BACKGROUND
  Hepatitis E virus (HEV) infections are a major cause of acute hepatitis in developing and industrialized countries. Little is known about anti-HEV immunity in solid-organ recipients.
  
  
  METHODS
  We screened 263 solid-organ recipients for anti-HEV immunoglobulin G (IgG) at transplantation. They were followed up for 1 year and tested for HEV RNA and anti-HEV antibodies 1 year after transplantation and if their liver enzyme activities increased.
  
  
  RESULTS
  A total of 38.4% had anti-HEV IgG at transplantation. The mean concentrations (±SD) of anti-HEV IgG at transplantation (8 ± 17.5 U/mL) and 1 year later (6.4 ± 12.0 U/mL, P = .4) were similar. There were 3 de novo HEV infections during the 1-year follow-up among patients who were HEV seronegative before transplantation, giving an annual incidence of 2.1%. We also identified 3 HEV reinfections among patients who were seropositive before transplantation through detection of HEV RNA, for an annual incidence of 3.3%. Their anti-HEV IgG concentrations were 0.3, 2.1, and 6.2 World Health Organization (WHO) units/mL before transplantation. Reinfection of the patient with the lowest IgG concentration at transplantation had evolved to a chronic infection.
  
  
  CONCLUSIONS
  Low anti-HEV antibodies (<7 WHO units/mL) seemed not to protect solid-organ recipients. HEV reinfection in immunocompromised patients can lead to chronic infection, as in primary infections.
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 National Reference Center for Hepatitis E, Laboratoire de virologie, Institut fédératif de biologie, Hôpital Purpan.
authors.forename: Florence
authors.initials: F
authors.lastname: Abravanel
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 National Reference Center for Hepatitis E, Laboratoire de virologie, Institut fédératif de biologie, Hôpital Purpan.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Lhomme
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 National Reference Center for Hepatitis E, Laboratoire de virologie, Institut fédératif de biologie, Hôpital Purpan.
authors.forename: Sabine
authors.initials: S
authors.lastname: Chapuy-Regaud
authors.affiliation: National Reference Center for Hepatitis E, Laboratoire de virologie, Institut fédératif de biologie, Hôpital Purpan.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Mansuy
authors.affiliation: Service de chirurgie viscérale et digestive, Hôpital Rangueil, CHU Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Service de Néphrologie, Dialyse et Transplantation multi-organe.
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 Service de Néphrologie, Dialyse et Transplantation multi-organe.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 Service de Néphrologie, Dialyse et Transplantation multi-organe.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.affiliation: Centre de Physiopathologie de Toulouse Purpan, INSERM U1043 National Reference Center for Hepatitis E, Laboratoire de virologie, Institut fédératif de biologie, Hôpital Purpan.
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
mesh_terms: D002908:Chronic Disease; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral
keywords: Hepatitis E virus; incidence; reinfection; solid organ transplant recipients