title: Lack of persistent hepatitis E virus infection as a cause for unexplained transaminase elevation in renal transplant recipients in India.
abstract: BACKGROUND
  Hepatitis E virus (HEV) infection is highly endemic in India, being the most common cause of acute hepatitis; however, no case of chronic infection has been reported. All the human isolates of HEV from India till date have belonged to genotype 1. In contrast, in non-endemic areas, genotype 3 is the most prevalent, and persistent HEV infection has been reported among solid-organ transplant recipients. Whether persistent infection occurs with genotype 1 HEV is unclear. We therefore looked for evidence of HEV infection among renal transplant recipients with elevated alanine transaminase (ALT).
  
  
  METHODS
  Renal transplant recipients receiving immunosuppressive therapy were screened for ALT levels, irrespective of time duration since renal transplant. For those with ALT levels equal to or exceeding 50 IU/mL on at least two occasions ≥3 weeks apart, serum was tested for HEV RNA using a sensitive real-time reverse transcription polymerase chain reaction assay. For those testing positive, HEV genotyping and follow up for duration of viral persistence were planned.
  
  
  RESULTS
  Of the 275 patients studied, 49 (17.8 %, 44 male, median age = 39.5 years) had elevated ALT levels (median = 62 [range = 50-477] IU/L). None of these 49 patients had detectable HEV RNA in the serum using an assay with detection sensitivity of 300 copies of RNA/mL of specimen.
  
  
  CONCLUSIONS
  Our data indicate that persistent HEV infection is an infrequent cause of ALT elevation in Indian renal transplant recipients who are receiving immunosuppressive drugs. This suggests that infection with genotype 1 HEV may have either no or low potential to cause persistent infection.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Munjal
authors.forename: Neha
authors.initials: N
authors.lastname: Gupta
authors.forename: Raj K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Narain
authors.initials: N
authors.lastname: Prasad
authors.forename: Anupama
authors.initials: A
authors.lastname: Kaul
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Bhadauria
authors.forename: Amit
authors.initials: A
authors.lastname: Goel
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D002648:Child; D005260:Female; D005838:Genotype; D016751:Hepatitis E / Q000097:blood / Q000201:enzymology*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D012367:RNA, Viral; D000410:Alanine Transaminase