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Volume 17, Number 1—January 2011

CME ACTIVITY

Hepatitis E Virus Infection without Reactivation in Solid-Organ Transplant Recipients, France

Florence Legrand-AbravanelComments to Author , Nassim Kamar, Karine Sandres-Saune, Sebastien Lhomme, Jean-Michel Mansuy, Fabrice Muscari, Federico Sallusto, Lionel Rostaing, and Jacques Izopet
Author affiliations: Author affiliations: Institut National de la Santé et de la Recherche Médicale, Toulouse, France (F. Legrand-Abravanel, N. Kamar, K. Sandres-Saune, S. Lhomme, L. Rostaing, J. Izopet); Centre Hospitalier Universitaire Toulouse, Toulouse (F. Legrand-Abravanel, N. Kamar, K. Sandres-Saune, S. Lhomme, J.-M. Mansuy, F. Muscari, F. Sallusto, L. Rostaing, J. Izopet)

Main Article

Table 1

Characteristics of 700 solid-organ transplant recipients and seroprevalence of antibodies against HEV before transplant, France, January 2004–December 2008*

Characteristic No. patients HEV IgG positive, no. (%) HEV IgM positive, no. (%)
Sex
M 459 57 (12.4) 8 (1.7)
F
241
32 (13.2)
9 (3.7)
Age at transplantation, y
<52 347 43 (12.4) 8 (2.3)
>52
363
46 (13.0)
9 (2.5)
Transplant type
Liver 171 21 (12.3) 4 (2.3)
Kidney
529
68 (12.8)
13 (2.4)
Cause of kidney transplantation
Glomerulonephritis 188 27 (14.3) 4 (2.1)
Genetic nephritis 102 15 (14.7) 1 (0.9)
Pyelonephritis or interstitial nephritis 92 7 (7.6) 2 (2.1)
Nephroangiosclerosis 82 9 (10.9) 2 (2.4)
Other
57
10 (17.5)
4 (7)
Cause of liver transplantation
Alcoholic cirrhosis 67 6 (8.9) 0
Hepatitis B or C 60 7 (11.6) 2 (3.3)
Autoimmune cirrhosis 9 2 (22) 1 (11)
Other
35
6 (17.1)
1 (2.8)
Hepatocarcinoma (yes/no) 64/107 9 (14) 2 (3.1)
Induction treatment (yes/no) 501/199 73 (14.5) 14 (2.8)
Interleukin-2 receptor blockers 292 40 (7.3) 4 (1.3)
Rabbit antithymocyte globulins
160
25 (15.6)
8 (5)
Immunosuppressive therapy at discharge
Belatacept 49 8 (16.3) 2 (16.3)
Cyclosporine A 182 27 (15.3) 1 (0.5)
Tacrolimus 442 52 (11.7) 14 (3.1)
Steroids 657 85 (12.9) 17 (2.5)
Mycophenolate 593 74 (12.5) 15 (2.6)
Azathioprine 2 0 0

*HEV, hepatitis E virus; Ig, immunoglobulin.

Main Article

1Based on results from this study, which of the following patients would be anticipated to be at highest risk for acquisition of hepatitis E virus (HEV) infection?

A. A 65-year-old man undergoing kidney transplantation

B. A 45-year-old woman undergoing liver transplantation

C. A 76-year-old man 1 year post liver transplant.

D. A 36-year-old woman 6 months post kidney transplant

2A 49-year-old female patient who is HIV positive undergoes a liver transplant. Six months later she is found to be HEV positive. Which of the following factors would increase her risk to evolve to a chronic infection?

A. Alcohol use

B. Female sex

C. Immunocompromise associated with HIV infection

D. Comorbid hepatitis C virus or hepatitis B virus infection

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