Prevalence of hepatitis E in liver transplant recipients in Greece

• Published in: Epidemiology and infection 2018-10, Vol.146 (13), p.1619-1621
• Main Authors: Sinakos, Ε., Gioula, G., Liava, Ch, Papa, A., Papadopoulou, E., Tsakni, E., Fouzas, I., Akriviadis, E.
• Format: Article
• Language: English
• Subjects: Calcineurin; Calcineurin inhibitors; Chronic infection; Enzymes; Genomes; Genotype & phenotype; Genotypes; Health risk assessment; Health risks; Hepatitis; Immunosuppressive agents; Infections; Infectious diseases; Laboratories; Liver; Liver transplantation; Liver transplants; Maximum likelihood method; Medical personnel; Nucleotide sequence; Patients; Phylogenetics; Phylogeny; Physicians; Polymerase chain reaction; Reverse transcription; Ribonucleic acid; RNA; Serology; Short Paper; Studies; Transplantation; Transplants & implants; Viral Hepatitis; Viral infections; Virology; Viruses
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268818001887

Hepatitis E virus (HEV) is a well-known cause of acute hepatitis. Immunocompromised subjects, including liver transplant recipients, are considered to be at risk for HEV infection, which occasionally follows a chronic course. The diagnosis of HEV infection in these patients must be based on HEV RNA testing, as serology has variable performance. The aim of this study was to assess the prevalence of HEV infection in liver transplant recipients in Greece by means of HEV RNA testing. Liver transplant recipients followed in the sole transplant centre in Greece were prospectively included. HEV RNA was detected by real-time RT-PCR. Positive samples were further analysed using a nested reverse transcription RT-PCR kit, which amplifies a 137-nucleotide sequence within the ORF2/ORF3 overlapping region to detect the HEV genotype and perform phylogenetic analysis. The mean age of the included patients (n = 76) was 54 years. The most common indication for liver transplantation was viral hepatitis (57%). The majority of the patients (75%) received a calcineurin inhibitor as part of their immunosuppressive regimen and had normal liver enzymes. HEV RNA was found positive in only 1/76 (1.3%) patient. Phylogenetic analysis showed that the sequence clustered into the HEV genotype 3 clade. This patient experienced an acute hepatitis flare, which nonetheless did not become chronic. The prevalence of HEV infection in liver transplant recipients in Greece is similar (1.3%) to that reported previously in other countries. Transplant physicians should be aware of this condition and its associated consequences.