Hepatitis E Virus Infection in Kidney Transplant Patients

Lim, Mary Ann; Kamili, Saleem; Cohen, Jordana B.; Green-Montfort, Tracy; Tejada‐Strop, Alexandra; Kohli, Jatinder; Drobeniuc, Jan; Patel, Priyanka; Vanderveen, Mary; Bloom, Roy D.

doi:10.1097/tp.0000000000002071

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…For other hepatitis viruses such as the hepatitis C virus, injection drug use is a known risk factor for transmission and a recent meta‐analysis found that hemodialysis is a risk factor for HEV infection 11,32,33 . Our findings on the high frequency of diabetics in our cohort are consistent with a previous study, which found that diabetes is a significant risk factor for hepatitis E, and they reported an odds ratio of 5.4 29 …”

Section: Discussionsupporting

confidence: 92%

“…The highest seroprevalence of HEV was noted among older individuals, non‐Hispanic Whites, individuals residing in the Midwest, and those born outside of the United States 27,28 . Other risk factors include diabetes and being a solid organ transplant recipient 29‐31 . Although injection drug use has been known to be a major risk factor for the transmission of hepatitis C virus in developed countries, injection/illicit drug use was not reported to be a risk factor for HEV exposure in nationwide studies 27,28,32,33 …”

Section: Introductionmentioning

confidence: 99%

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Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017

Wasuwanich

Ingviya

Thawillarp

et al. 2021

Journal of Viral Hepatitis

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Hepatitis E is considered rare in the United States (US) despite its widespread occurrence in Asian and African countries. The objective of this study was to describe the characteristics of hepatitis E‐related pregnancies and acute‐on‐chronic liver failure and analyse trends for hepatitis E diagnosis among hospitalized patients in the US. We examined data from the 2010–2017 National Inpatient Sample from Healthcare Cost and Utilization Project to determine mortality, morbidity, pregnancy diagnoses, chronic liver disease diagnoses, and other conditions during hospitalization. Data were extracted for hospitalizations with hepatitis E as defined by ICD‐9 codes 070.43 and 070.53 and ICD‐10 code B17.2. Of 208,462,242 hospitalizations from 2010–2015, we identified 960 hepatitis E hospitalizations. The hospitalization rate of hepatitis E was 3.7 per 10 million in 2010 and 6.4 per 10 million in 2015 (β = 0.60, p = 0.011). From 2015 to 2017, the hospitalization appeared to increase with slope (β) of 0.50. Among those hospitalizations, 34 (4%) died and 85 (9%) had acute‐on‐chronic liver failure. Ninety‐five (10%) had a diagnosis of pregnancy, there were no reports of maternal or foetus/neonate deaths, but there was a high proportion of adverse events for both during hospitalization. Having a chronic liver disease was associated with hepatic coma diagnosis (OR = 10.94, p = 0.002). Although the hospitalization rate of hepatitis E in the US is low, it appears to be increasing over time. Further studies are necessary in order to conclude a causal association of hepatitis E with adverse events and mortalities in pregnancy and chronic liver disease in the US.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017

Wasuwanich

Ingviya

Thawillarp

et al. 2021

Journal of Viral Hepatitis

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“…The association of renal transplantation with an increased prevalence of HEV‐IgG was previously reported in a U.S. study using paired serum samples from individuals pre‐ and post‐kidney transplantation 21 wherein the prevalence of anti‐HEV increased from 19% pre‐transplant to 26% post‐transplant. In that study, the factors associated with anti‐HEV positivity were diabetes mellitus, and concomitant BK‐virus and cytomegalovirus infections, suggesting an influence of the degree of immunosuppression 21 . Similarly, we speculate that the higher seroprevalence in kidney transplant recipients in our study could be due to their need for higher doses of immunosuppression compared with liver or liver–kidney transplant recipients, 35,36 although exposure through chronic dialysis might also be a factor 37,38 …”

Section: Discussionmentioning

confidence: 56%

“…While this difference was modest in the pre‐ and post‐liver transplant subjects, the divergence was striking in the kidney transplant recipients compared with waitlist patients. The association of renal transplantation with an increased prevalence of HEV‐IgG was previously reported in a U.S. study using paired serum samples from individuals pre‐ and post‐kidney transplantation 21 wherein the prevalence of anti‐HEV increased from 19% pre‐transplant to 26% post‐transplant. In that study, the factors associated with anti‐HEV positivity were diabetes mellitus, and concomitant BK‐virus and cytomegalovirus infections, suggesting an influence of the degree of immunosuppression 21 .…”

Section: Discussionmentioning

confidence: 56%

“…A report from France suggested that as many as two‐thirds of transplant recipients with acute HEV infection progress to chronic hepatitis, of whom cirrhosis developed in 14% 10,18,19 . Existing data from the United States (U.S.) suggest a high prevalence of HEV infection post‐transplant, but studies are limited, retrospective and primarily restricted to kidney transplant recipients 20,21 . It is uncertain if solid‐organ transplant recipients in the U.S. are at increased risk for HEV infection and, if so, what are the risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis E prevalence and infection in solid‐organ transplant recipients in the United States

Samala

Wang

Auh

et al. 2022

Journal of Viral Hepatitis

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Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide.An increased risk for HEV infection has been reported in organ-transplant recipients, mainly from Europe. Prospective data on HEV prevalence in the United States (U.S.) organ transplant population are limited. To determine the prevalence and factors associated with HEV infection among solid organ transplant-recipients, we conducted a prospective, cross-sectional, multicentre study among transplant-recipients and ageand organ-matched waitlist patients. Participants answered a risk-exposure questionnaire and were tested for HEV-RNA (in-house PCR), HEV-IgG, and IgM (ELISA, Wantai). Among 456 participants, 224 were transplant-recipients, and 232 were waitlist patients. The mean age was 58 years, 35% female, and 74% White. HEV seroprevalence of the entire cohort was 20.2% and associated with older age (p < 0.0001) and organ transplantation (p = 0.02). The HEV seropositivity was significantly higher among transplant-recipients compared with waitlist patients (24% vs. 16.4%, p = 0.042). Among transplant recipients, relative-risk of being HEV seropositive increased with older age ] in patients >70 years compared with ≤50 years, p = 0.037); history of graft hepatitis (2.2 [1.27-3.72], p = 0.005); calcineurin inhibitor use (RR = 1.9 [1.03-3.34], p = 0.02); and kidney transplantation (2.4 [1.15-5.16], p = 0.02). HEV-RNA, genotype 3 was detected in only two patients (0.4%), both transplant-recipients. HEV seroprevalence was higher among transplant-recipients than waitlist patients. HEV should be considered in transplant-recipients presenting with graft hepatitis. Detection of HEV-RNA was rare, suggesting that progression to chronic HEV infection is uncommon in transplant-recipients in the U.S.

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Hepatitis E Diagnosis and Management After Liver, Kidney, or Heart Transplant: A Single-Center Experience

Carter

Solsrud

Yeddula

et al. 2022

Transplantation Proceedings

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Hepatitis E Virus Infection in Kidney Transplant Patients

Cited by 5 publications

References 3 publications

Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017

Hepatitis E‐Associated Hospitalizations in the United States: 2010–2015 and 2015–2017

Hepatitis E prevalence and infection in solid‐organ transplant recipients in the United States

Hepatitis E Diagnosis and Management After Liver, Kidney, or Heart Transplant: A Single-Center Experience

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