Hepatitis E virus reinfections in solid-organ-transplant recipients can evolve into chronic infections

J Infect Dis. 2014 Jun 15;209(12):1900-6. doi: 10.1093/infdis/jiu032. Epub 2014 Jan 16.


Background: Hepatitis E virus (HEV) infections are a major cause of acute hepatitis in developing and industrialized countries. Little is known about anti-HEV immunity in solid-organ recipients.

Methods: We screened 263 solid-organ recipients for anti-HEV immunoglobulin G (IgG) at transplantation. They were followed up for 1 year and tested for HEV RNA and anti-HEV antibodies 1 year after transplantation and if their liver enzyme activities increased.

Results: A total of 38.4% had anti-HEV IgG at transplantation. The mean concentrations (±SD) of anti-HEV IgG at transplantation (8 ± 17.5 U/mL) and 1 year later (6.4 ± 12.0 U/mL, P = .4) were similar. There were 3 de novo HEV infections during the 1-year follow-up among patients who were HEV seronegative before transplantation, giving an annual incidence of 2.1%. We also identified 3 HEV reinfections among patients who were seropositive before transplantation through detection of HEV RNA, for an annual incidence of 3.3%. Their anti-HEV IgG concentrations were 0.3, 2.1, and 6.2 World Health Organization (WHO) units/mL before transplantation. Reinfection of the patient with the lowest IgG concentration at transplantation had evolved to a chronic infection.

Conclusions: Low anti-HEV antibodies (<7 WHO units/mL) seemed not to protect solid-organ recipients. HEV reinfection in immunocompromised patients can lead to chronic infection, as in primary infections.

Keywords: Hepatitis E virus; incidence; reinfection; solid organ transplant recipients.

MeSH terms

  • Chronic Disease
  • Female
  • Hepatitis Antibodies / blood
  • Hepatitis E / diagnosis
  • Hepatitis E / epidemiology*
  • Hepatitis E / immunology
  • Hepatitis E virus / isolation & purification*
  • Humans
  • Immunocompromised Host*
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Incidence
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / immunology
  • Prospective Studies
  • RNA, Viral / blood


  • Hepatitis Antibodies
  • Immunoglobulin G
  • Immunoglobulin M
  • RNA, Viral