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Volume 17, Number 1—January 2011

CME ACTIVITY - Research

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 3

Analysis of risk factors for acquiring HEV infection in 601 solid-organ transplant recipients, France, January 2004–December 2008*

Characteristic Univariate analysis
Multivariate analysis
Relative risk (95% CI) p value Relative risk (95% CI) p value
Male sex 1.56 (0.73–3.35) 0.24
Age at transplantation <52 y 2.58 (1.20–5.53) 0.01 2.8 (1.3–6.0) 0.008
Living in rural area (<20,000 inhabitants) 0.6 (0.28–1.32) 0.21
Having a liver transplant 1.78 (0.88–3.60) 0.10 2.03 (1–4.13) 0.05
Indication of liver transplantation
Alcohol 0.95 (0.29–3.10) 0.94
Hepatitis B or C 1.34 (0.47–3.80) 0.58
Autoimmune 3.1 (0.75–13.15) 0.11
Other causes 2.52 (0.77–8.24) 0.12
Indication of kidney transplantation
Glomerulonephritis 0.49 (0.19–1.28) 0.15
Genetic nephritis 1.06 (0.37–3.02) 0.90
Pyelonephritis or interstitial nephritis 0.20 (0.02–1.52) 0.13
Nephroangiosclerosis 1.45 (0.55–3.68) 0.46
Other causes 2.52 (0.77–8.24) 0.12
Induction therapy
Yes 0.83 (0.39–1.74) 0.62
ATG 1.19 (0.53–2.65) 0.66
Anti-IL2R 0.95 (0.49–1.94) 0.95
Immunosuppressive therapy at discharge
Belatacept 0.49 (0.06–3.60) 0.48
Cyclosporine A 0.72 (033–1.55) 0.41
Tacrolimus 1.49 (0.73–3.07) 0.27
Steroids 0.74 (0.17–3.11) 0.68
Mycophenolate 0.84 (0.34–2.02) 0.69
Azathioprine 0 1
Double regimen 1.07 (0.50–2.30) 0.85 ­–
Triple regimen 0.99 (0.46–2.13) 0.99

*HEV, hepatitis E virus: CI, confidence interval; –, not significant; ATG, antithymoglobulin; anti-IL2R, interleukin-2 receptor blockers.

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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