Prevalence of hepatitis E virus infection in pediatric solid organ transplant recipients--a single-center experience

Area of Science:

• Hepatology
• Virology
• Transplant Immunology

Background:

• Hepatitis E virus (HEV) infection is an emerging public health concern in industrialized nations.
• Solid organ transplantation in children increases susceptibility to infections, including HEV.
• Data on HEV prevalence and outcomes in pediatric transplant recipients are limited.

Purpose of the Study:

• To determine the seroprevalence of HEV infection in pediatric liver and kidney transplant recipients.
• To assess HEV RNA shedding in seropositive transplant patients.
• To compare HEV seroprevalence in pediatric transplant recipients with immunocompetent children.

Main Methods:

• Screening of 124 pediatric solid organ transplant recipients (liver/kidney) for anti-HEV IgG antibodies.
• Testing for fecal HEV RNA in anti-HEV IgG-positive patients.
• Comparison with 108 age-matched immunocompetent pediatric controls screened for anti-HEV IgG.

Main Results:

• Overall HEV seroprevalence was 3.2% in transplant recipients (2.4% renal, 4.9% liver).
• Three of four seropositive transplant patients were HEV RNA-negative; one developed chronic HEV genotype 3 infection.
• HEV IgG seroprevalence in controls was 7.4%, with no biochemical evidence of hepatitis.

Conclusions:

• HEV infection prevalence is similar in pediatric transplant recipients and immunocompetent children.
• Pediatric transplant recipients are at risk for chronic HEV infection and persistent viral carriage.
• HEV should be considered in the differential diagnosis of hepatitis in both immunosuppressed and immunocompetent children.