Miriam EC Frankal [1,2,3], Catarina Skoglund [4,5], Maria E Castedal [4,5], Martin Lagging [1,6], Heléne ML Norder [1,6].

Affiliates

Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden [1] Region Västra Götaland, Södra Älvsborg Hospital, Clinic of infectious diseases, Borås, Sweden [2] Region Västra Götaland, Södra Älvsborg Hospital, Department of Research, Education and Innovation, Borås, Sweden [3] Region Västra Götaland, Sahlgrenska University Hospital, Transplant Institute, Gothenburg, Sweden [4] Department of Surgery, Institute of Clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden [5] Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden [6]

Abstract

Background: Following exposure to hepatitis E virus (HEV), liver transplant (LT) recipients have increased risk of developing chronic infection, which may rapidly progress to severe liver damage if not treated. The prevalence of HEV infection after liver transplantation is unclear and likely varies geographically. The aim of this study was to investigate the prevalence of acute and chronic HEV infection among LT recipients in an HEV endemic region.
Methods: During 2013-2015, 109 out of 152 prospectively enrolled patients listed for liver transplantation received a liver graft and completed the study protocol. They were evaluated for anti-HEV IgM, HEV-IgG and HEV RNA at the time of liver transplantation, 3- and 12-months post-transplant. Medical records were reviewed.
Results: Twelve (11%) LT recipients acquired markers of HEV infection during the study period. Seven patients (6%) had detectable HEV RNA, one prior to transplantation, three at the 3-months and another three at the 12 months follow-up post-transplant. All resolved their infections without treatment and had undetectable HEV-RNA at the succeeding follow-up. Another five (5%) patients developed anti-HEV antibodies without detectable HEV RNA as an indication of HEV infection during follow-up. Signs and symptoms of HEV infection were subtle and none was diagnosed in routine clinical care.
Conclusions: A substantial proportion of LT recipients in Sweden are at risk of acquiring HEV infection, both before and after transplantation. The results highlight the frequency of silent, spontaneously resolving HEV infections, and does not support universal screening of LT recipients in Sweden, despite HEV being a potentially treatable infection.