The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study.
Michelle Zicker, João R R Pinho, Eliane A R Welter, Bianca D Guardia, Paulo G T M da Silva, Leonardo B da Silveira, Luís F A Camargo
Author Information
Michelle Zicker: Division of Infectious Diseases, Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil. ORCID
João R R Pinho: Research and Development Sector, Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil. ORCID
Eliane A R Welter: Research and Development Sector, Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil. ORCID
Bianca D Guardia: Liver Transplant Program, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil. ORCID
Paulo G T M da Silva: Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil. ORCID
Leonardo B da Silveira: Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil. ORCID
Luís F A Camargo: Division of Infectious Diseases, Department of Internal Medicine, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil.
The hepatitis E virus is a major etiological agent of chronic hepatitis in immunosuppressed individuals. Seroprevalence in the liver transplantation setting varies according to the seroprevalence of the general population in different countries. This was a prospective cohort study of liver transplant recipients in southeastern Brazil. Recipients were systematically followed for one year, with the objective of determining the prevalence, incidence, and natural history of HEV infection in this population. We included 107 liver transplant recipients and 83 deceased donors. Positivity for anti-HEV IgG was detected in 10.2% of the recipients and in 9.7% of the donors. None of the patients tested positive for HEV RNA at baseline or during follow-up. There were no episodes of reactivation or seroconversion, even in cases of serological donor-recipient mismatch or in recipients with acute hepatitis. Acute and chronic HEV infections seem to be rare events in the region studied. That could be attributable to social, economic, and environmental factors. Our data indicate that, among liver transplant recipients, hepatitis E should be investigated only when there are elevated levels of transaminases with no defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation.
