Volume 17, Number 1—January 2011
CME ACTIVITY - Research
Hepatitis E Virus Infection without Reactivation in Solid-Organ Transplant Recipients, France
, Nassim Kamar, Karine Sandres-Saune, Sebastien Lhomme, Jean-Michel Mansuy, Fabrice Muscari, Federico Sallusto, Lionel Rostaing, and Jacques Izopet
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.
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