Chronic hepatitis E and hepatitis E seroprevalence in immunosuppressed patients: a prospective study

Hepatitis E virus (HEV) is the commonest cause of acute viral hepatitis in Western countries. Immunocompromised patients may develop chronic hepatitis. This study aims at determining the seroprevalence and the prevalence of chronic HEV infections in a single tertiary center in Belgium.

From May 2022 to April 2023, we prospectively screened for HEV [immunoglobulin G (IgG), immunoglobulin M (IgM), and polymerase chain reaction (PCR)] all patients transplanted from a solid organ transplantation (SOT) and patients suffering from a lymphoma or followed for a bone marrow transplantation.

A total of 740 patients were included: 335 followed for a kidney transplantation (KT), 136 for a heart transplantation (HT), 200 for a liver transplantation (LT), and 69 for a hematological disease (HD). The HEV seroprevalence of the total population is 9.9%. In subgroup analysis, the HEV seroprevalence is 11% for the HT patients, 8.4% for the KT patients, 14% for the LT patients, and 2.9% for the patients followed for HD. There was a significant difference for HEV seroprevalence between HDs and HT group (P=0.046) and between HD and LT group (P=0.01). The identified risk factors for HEV seropositivity were age and being liver transplanted. In the total population, we identified 5 patients with chronic HEV (0.6%), all of them were kidney transplanted patients. HEV clearance was not achieved after decreasing immunosuppression, and a ribavirin treatment was initiated.

HEV IgG seroprevalence in our immunosuppressed population is 9.9%. Chronic HEV was found in 0.6% of the patients, all kidney transplanted and having required ribavirin treatment.