Prevalence of hepatitis E in liver transplant recipients in Greece

Sinakos, Emmanouil; Liava, Christina; Papa, Anna; Papadopoulou, Elpida; Tsakni, Ekaterini; Fouzas, I.; Akriviadis, Evangelos

doi:10.1017/s0950268818001887

Cited by 11 publications

(20 citation statements)

References 15 publications

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“…The only patient that tested RNA positive experienced acute hepatitis flare without progression into chronic form. The HEV RNA prevalence in the Greek transplant population (1.3%) corresponds with previously reported data in immunocompromised patients from other European countries[45].…”

Section: Greecesupporting

confidence: 87%

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

Mrzljak¹,

Dinjar-Kujundzic²,

Jemeršić³

et al. 2019

WJG

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The significance of hepatitis E virus (HEV) as an important public health problem is rising. Until a decade ago, cases of HEV infection in Eur-ope were mainly confined to returning travelers, but nowadays, hepatitis E represents an emerging zoonotic infection in many European countries. The aim of this manuscript is to perform a systematic review of the published literature on hepatitis E distribution in humans, animals and environmental samples ("One Health" concept) in the South-Eastern European countries. Comparison of the available data showed that the anti-HEV seroprevalence in the South-Eastern Europe varies greatly, depending on the population studied, geographical area and methods used. The IgG seroprevalence rates in different population groups were found to be 1.1%-24.5% in Croatia, up to 20.9% in Bulgaria, 5.9-%17.1% in Romania, 15% in Serbia, up to 9.7% in Greece and 2%-9.7% in Albania. Among possible risk factors, older age was the most significant predictor for HEV seropositivity in most studies. Higher seroprevalence rates were found in animals. HEV IgG antibodies in domestic pigs were detected in 20%-54.5%, 29.2%-50%, 38.94%-50% and 31.1%-91.7% in Serbia, Bulgaria, Romania and Croatia, respectively. In wild boars seroprevalence rates were up to 10.3%, 30.3% and 31.1% in Romania, Slovenia and Croatia, respectively. A high HEV RNA prevalence in wild boars in some countries (Croatia and Romania) indicated that wild boars may have a key role in the HEV epidemiology. There are very few data on HEV prevalence in environmental samples. HEV RNA was detected in 3.3% and 16.7% surface waters in Slovenia and Serbia, respectively. There is no evidence of HEV RNA in sewage systems in this region. The available data on genetic characterization show that human, animal and environmental HEV strains mainly belong to the genotype 3.

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Section: Greecesupporting

confidence: 87%

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

Mrzljak¹,

Dinjar-Kujundzic²,

Jemeršić³

et al. 2019

WJG

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“…Anti‐HEV IgM seroprevalence ranged between 0.35% and 4.1% in Western countries 9,10,17 and 0.05% and 10% in Eastern studies 16,19 . Finally, HEV RNA positivity ranged between 0% and 1.4% in Western countries 9,10,12,15,17,18,20–23 and 0% and 7.7% in the 3 Eastern studies 16,19,24 …”

Section: Resultsmentioning

confidence: 98%

“…The percentage of male LT recipients in the cohorts ranged from 51.2% to 83.3% 9,10,13–19,21,23,24 . At the time of evaluation (ranging from 3 to 107 months post‐LT) 9,10,15,16,19,21,23,24 the mean/median values of AST, ALT and bilirubin were from 24 to 59 IU/L, 10,15,16,24 19 to 71 IU/L 10,11,13,15,16,24 and 4 to 36 μmol/L, 10,11,15,16,24 respectively. Based on the available data, 34 of the 5227 LT recipients tested for HEV RNA had confirmed HEV infection at 5.5 to 96 months post‐LT 10,15,16,18,20,21 having mean/median AST, ALT and bilirubin levels from 29.5 to 250 IU/L, 15,16,18 22.8 to 250 IU/L 15,16,18,20,24 and 10.3 to 198 μmol/L, 15,16,18,20 respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Among the six studies published between 2009 and 2014, 9–14 only three evaluated HEV RNA (with 9,10 or without 12 HEV Abs) including 820 (53%) recipients. In contrast, all the studies published between 2015 and 2020, 15–24 evaluated HEV RNA (with 16,17,19,23,24 or without HEV Abs 15,18,20–22 ). The seroprevalence of anti‐HEV IgG ranged from 3.16% to 27.7% and 2.9% to 53.3% (24.4% in the only European cohort reporting IgG) between 2009 and 2014 and between 2015 and 2020, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of HEV infection (HEV RNA positivity) based on sex was reported in 3 studies [ N = 589] 10,15,21 and ranged from 1.5% to 2.4% in males, while it was 0% in female recipients. Out of the total number of LT recipients diagnosed with HEV infection, the number of male patients ranged from 55.5% in one British cohort 20 to 100% in 3 cohorts 15,21,22 …”

Section: Resultsmentioning

confidence: 99%

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Epidemiology and treatment of hepatitis E in the liver transplantation setting: A literature review

Markakis

Papatheodoridis

2022

Journal of Viral Hepatitis

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Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing countries, but it can also take a chronic course especially in immunocompromised patients. Its epidemiology after liver transplantation (LT) is hard to assess and treatment options are still explored. Between 2009 and 2020, literature reporting HEV prevalence and treatment in LT recipients was searched and a synthesis was attempted. Sixteen studies reported HEV prevalence in consecutive LT patients: HEV RNA positivity ranged between 0%–1.4% and 0%–7.7% for Western and Eastern cohorts, respectively. In studies published between 2009–2014 and 2015–2020, HEV RNA positivity ranged between 0.35%–1.3% (all European) and 0%–7.7% (European: 0%–1.4%), respectively. Five studies evaluated HEV prevalence in LT recipients with abnormal liver enzymes: HEV RNA positivity was 2.9% in studies published between 2009 and 2014 and from 3.5% to 20% in studies published between 2015 and 2020. Twenty‐seven studies reported HEV treatment in LT recipients: sustained virologic response was achieved in 15% by immunosuppression reduction alone and in 83% of cases by ribavirin regiments. Chronic HEV infection is affecting LT recipients, mostly those with abnormal liver enzymes and in Eastern countries. HEV diagnoses should be based on PCR techniques. Successful treatment can be achieved with ribavirin in most cases.

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Journal Summary: Hepatitis E Virus Infection after Liver Transplantation

Thandassery,

Kaur,

Sharma

2023

Journal of Gastrointestinal Infections

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In a recent prospective multicenter cross-sectional study, Samala et al studied the seroprevalence of hepatitis E virus (HEV) in waitlist and post-transplant patients in the United States. Large multicenter studies regarding HEV infection in the transplant cohort are lacking in the United States, and this prospective multicenter cross-sectional study described higher-than-expected HEV seroprevalence. 1 They studied 456 participants (224 had solid organ transplants, and 232 were on the waiting list). Subjects (above 18 years) after organ transplant and those on the waiting list matched for age, organ, as well as transplant center were enrolled. Organs transplanted include liver, intestine, kidney, and liver-kidney. Among post-transplant patients, those after 1 year of transplantation were included, as they were likely on a stable immunosuppressive regimen. Enrolment of transplant recipients was stratified based on the site and the number of years post-transplant: 1, 2, and more than 3 years.The seropositivity of HEV infection for the whole study groups was 20.2%. The seropositivity was higher in the posttransplant group compared with the waitlist group. In the entire study group, HEV seropositive status was associated with higher age and organ transplantation. In the posttransplant group, older age, calcineurin inhibitor use, and history of graft hepatitis were associated with seropositivity. Authors suggested that HEV infection should be suspected in transplant recipients under evaluation with abnormal liver function tests (LFTs). However, they also noted that detection of HEV-RNA was rare, indicating that development of chronic HEV infection is not common in patients after organ transplantation in the United States. Other studies from the United States are usually limited retrospective studies and mainly included only kidney transplant patients.

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Prevalence of hepatitis E in liver transplant recipients in Greece

Cited by 11 publications

References 15 publications

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

Epidemiology and treatment of hepatitis E in the liver transplantation setting: A literature review

Journal Summary: Hepatitis E Virus Infection after Liver Transplantation

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