Toward Systematic Screening for Persistent Hepatitis E Virus Infections in Transplant Patients

Area of Science:

• Virology
• Immunology
• Transplant Medicine

Background:

• Persistent hepatitis E virus genotype 3 (HEV G3) infections are a known risk for solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients.
• The prevalence of HEV G3 in these patient cohorts within the United Kingdom was previously unknown.

Purpose of the Study:

• To determine the point prevalence of HEV viremia in SOT and HSCT patients in the UK.
• To compare different HEV testing approaches to inform future screening strategies.

Main Methods:

• A prospective audit screened 3044 patients undergoing therapeutic drug monitoring for HEV RNA in minipools.
• 2822 patients were characterized (2419 SOT, 144 HSCT, 259 unknown transplant history).
• HEV RNA-positive samples underwent serology and genomic phylogeny. HEV antigen (HEV-Ag) testing was performed on selected samples.

Main Results:

• A prevalence of 0.67% (19/2822) for G3 HEV viremia was identified.
• HEV viremic patients had significantly higher alanine aminotransferase levels, though some had normal levels.
• The HEV-Ag assay detected 18 of 19 viremic patients, including those with established infections.

Conclusions:

• UK transplant recipients face a low but significant risk of HEV infection.
• HEV-Ag detection is a potential alternative to RNA testing for identifying persistent HEV infections, especially when resources are limited.