Haagsma Elizabeth B, Niesters Hubert G M, van den Berg Arie P, Riezebos-Brilman Annelies, Porte Robert J, Vennema Harry, Reimerink Johan H J, Koopmans Marion P G
Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Liver Transpl. 2009 Oct;15(10):1225-8. doi: 10.1002/lt.21819.
Hepatitis E virus (HEV) infection is known to run a self-limited course. Recently, chronic hepatitis E has been described in several immunosuppressed patients after solid organ transplantation. The prevalence of HEV infection after transplantation, however, is unknown. We studied HEV parameters [HEV RNA, HEV immunoglobulin M (IgM), and HEV immunoglobulin G (IgG) by enzyme-linked immunosorbent assay and confirmatory immunoblotting] in a cohort of 285 adult liver transplant recipients. The most recent freeze-stored sera were investigated, and if they were positive, a retrospective analysis was performed. Samples from 274 patients (96.1%) tested negative for all HEV parameters. This included a patient described earlier as having experienced an episode of chronic HEV hepatitis in the past. One patient was found positive for HEV RNA without HEV antibodies. She presently suffers from chronic HEV hepatitis and has also been described before. Sera from 9 patients tested positive for HEV IgG without HEV IgM or HEV RNA. Six of these 9 patients (2.1% of the total) were found to have HEV IgG antibodies in retrospect related to an HEV infection at some time pre-transplant as they also tested positive in a pretransplant serum sample. One of these 9 patients suffered in retrospect from a chronic HEV infection with mild hepatitis between 2 and 5 years after liver transplantation on the basis of the course of HEV RNA, IgM, and IgG, aminotransferases, and liver histology. Overall, the prevalence of acquired HEV hepatitis after liver transplantation was 1% in this cohort. We conclude that liver transplant recipients have a risk for chronic HEV infection, but the prevalence is low.
戊型肝炎病毒（HEV）感染通常呈自限性病程。最近，在一些实体器官移植后的免疫抑制患者中发现了慢性戊型肝炎。然而，移植后HEV感染的患病率尚不清楚。我们对285名成年肝移植受者进行了队列研究，检测了HEV参数[通过酶联免疫吸附测定和确证免疫印迹法检测HEV RNA、HEV免疫球蛋白M（IgM）和HEV免疫球蛋白G（IgG）]。研究了最新的冻存血清，若血清呈阳性，则进行回顾性分析。274名患者（96.1%）的所有HEV参数检测均为阴性。这其中包括一名之前被描述为曾患慢性戊型肝炎的患者。有一名患者HEV RNA呈阳性，但无HEV抗体。她目前患有慢性戊型肝炎，之前也曾被报道过。9名患者的血清HEV IgG呈阳性，但无HEV IgM或HEV RNA。在这9名患者中，有6名（占总数的2.1%）回顾性分析发现其在移植前的某个时间曾感染HEV，因为他们移植前的血清样本检测也呈阳性。根据HEV RNA、IgM、IgG、转氨酶和肝脏组织学变化过程，这9名患者中有1名在肝移植后2至5年回顾性诊断为慢性HEV感染伴轻度肝炎。总体而言，该队列中肝移植后获得性戊型肝炎的患病率为1%。我们得出结论，肝移植受者有慢性HEV感染的风险，但患病率较低。
