Prevalence and clinical consequences of Hepatitis E in patients who underwent liver transplantation for chronic Hepatitis C in the United States.
BACKGROUND
Infection with hepatitis E virus (HEV) in immunocompromised patients can lead to severe liver disease. Treatment options for HEV include peginterferon or ribavirin, routinely also used for the treatment of hepatitis C virus (HCV) infection. We determined the prevalence and clinical consequences of HEV in United States (US) based patients who underwent liver transplantation (LT) for chronic HCV.


METHODS
Seroprevalence of HEV in 145 US LT recipients with a history of chronic HCV was determined pre-LT, 1, 3 and 5 years post-LT. All last available samples and all samples in IgM positive patients and post-LT IgG seroconverters were tested for HEV RNA.


RESULTS
Overall anti-HEV seroprevalence was 42 %. Five patients were HEV IgM positive pre-LT, one patient had IgM seroconversion post-LT and eight patients had IgG seroconversion post-LT. None of the tested samples were positive for HEV RNA. Eight out of nine of the post-LT seroconverters had been treated for HCV recurrence before or at the moment of seroconversion.


CONCLUSIONS
LT recipients in the US are at risk of acquiring HEV. Post-LT HCV treatment with interferons and/or ribavirin may have protected patients against chronic HEV. With the arrival of new direct antiviral agents for the treatment of HCV and the elimination of peginterferon and ribavirin from HCV treatment regimens, the prevalence of chronic HEV in this population may rise again.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. l.koning.1@erasmusmc.nl.|Mayo Clinic Transplant Center, Rochester, MN, USA. l.koning.1@erasmusmc.nl.
Ludi
L
Koning
Intermountain Medical Center, Transplant Center, Salt Lake City, UT, USA. Michael.Charlton@imail.org.
Michael R
MR
Charlton
Department of Viroscience, Erasmus University Medical Center, room NA-1019, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. s.pas@erasmusmc.nl.
Suzan D
SD
Pas
Mayo Clinic Transplant Center, Rochester, MN, USA. Heimbach.Julie@mayo.edu.
Julie K
JK
Heimbach
Department of Viroscience, Erasmus University Medical Center, room NA-1019, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. a.osterhaus@erasmusmc.nl.
Albert D M E
AD
Osterhaus
Mayo Clinic Transplant Center, Rochester, MN, USA. Watt.Kymberly@mayo.edu.
Kymberly D
KD
Watt
Toronto Centre for Liver Disease, Toronto Western & General Hospital, University Health Network, Toronto, Canada. Harry.Janssen@uhn.ca.
Harry L A
HL
Janssen
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. r.deknegt@erasmusmc.nl.
Robert J
RJ
de Knegt
Department of Viroscience, Erasmus University Medical Center, room NA-1019, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. a.vandereijk@erasmusmc.nl.
Annemiek A
AA
van der Eijk
D000328:Adult; D005260:Female; D019698:Hepatitis C, Chronic / Q000601:surgery*; D016751:Hepatitis E / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D016752:Hepatitis E virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology
D012367:RNA, Viral