Binda Barbara, Picchi Giovanna, Bruni Roberto, Di Gasbarro Alessandro, Madonna Elisabetta, Villano Umbertina, Pisani Giulio, Carocci Alberto, Marcantonio Cinzia, Montali Filippo, Panarese Alessandra, Pisani Francesco, Ciccaglione Anna Rita, Spada Enea
General and Transplant Surgery Department, San Salvatore Hospital, 67100 L'Aquila, Italy.
Department of Clinical Medicine, Life, Health and Environmental Sciences-MESVA, University of L'Aquila, 67100 L'Aquila, Italy.
Viruses. 2025 Mar 31;17(4):502. doi: 10.3390/v17040502.
Hepatitis E virus (HEV) infection can become chronic in immunocompromised patients, like solid organ transplant recipients (SOTRs). We evaluated HEV prevalence, risk factors, and outcomes among SOTRs in a hyperendemic HEV area. Three hundred SOTRs were enrolled from April to July 2019 and tested for anti-HEV IgM and IgG and HEV RNA. Sixty-three recipients (21%) were positive for any HEV marker. HEV infection was independently associated with older age and pork liver sausage consumption. Three viremic recipients harbored genotype 3e and 3f according to HEV RNA sequencing and phylogenetic analysis. Overall, 10 recipients had markers of active/recent infection (HEV RNA and/or anti-HEV IgM) and were followed up prospectively. Five of them spontaneously resolved their HEV infection. In two recipients, HEV clearance was achieved only through immunosuppression reduction, while three needed ribavirin therapy to achieve virologic resolution. We observed a chronic course in 30% of SOTRs with active/recent HEV infection. No association was found between tacrolimus assumption and chronicization. In conclusion, we found a high prevalence of infection among SOTRs attending a transplant center in a hyperendemic Italian HEV region. Systematic screening for all HEV markers and dietary education for infection control are needed for transplant recipients.
戊型肝炎病毒（HEV）感染在免疫功能低下的患者中可能会发展为慢性感染，如实体器官移植受者（SOTR）。我们评估了戊型肝炎病毒高度流行地区SOTR中的HEV流行情况、危险因素及转归。2019年4月至7月纳入300名SOTR，检测其抗HEV IgM、IgG及HEV RNA。63名受者（21%）的任何HEV标志物检测呈阳性。HEV感染与年龄较大及食用猪肝香肠独立相关。根据HEV RNA测序和系统发育分析，3名病毒血症受者携带3e和3f基因型。总体而言，10名受者有活动性/近期感染标志物（HEV RNA和/或抗HEV IgM）并接受前瞻性随访。其中5名受者的HEV感染自行缓解。2名受者仅通过减少免疫抑制实现了HEV清除，而3名受者需要利巴韦林治疗才能实现病毒学缓解。我们观察到30%有活动性/近期HEV感染的SOTR病程呈慢性。未发现使用他克莫司与疾病慢性化之间存在关联。总之，我们发现意大利戊型肝炎病毒高度流行地区一家移植中心的SOTR中感染率很高。移植受者需要对所有HEV标志物进行系统筛查并开展饮食教育以控制感染。
