Clinical significance of post-liver transplant hepatitis E seropositivity in high prevalence area of hepatitis E genotype 3: a prospective study

High hepatitis E (HEV) seroprevalence has been reported in the general population and in post-liver transplant (LT) cases in several regions, including Thailand, with genotype 3 being a predominant genotype. We hypothesized that HEV might persist at a subclinical level and might pose clinical risks in the post-LT period. We performed a cross-sectional study with 108 post-LT patients and found an IgG seroprevalence of 55.6%. Subsequently, 91 cases without clinical evidence of HEV-related hepatitis were enrolled in 1 year of prospective follow-up to determine clinical status, serologies and serum/feces HEV RNA every 4 months. HEV RNA was detected, indicating subclinical infections in patients with or without seropositivity, with an annual incidence of 7.7%. Our results suggest that subclinical HEV infection exists among LT patients in this high-prevalence area. Thus, clinicians should be aware of the possibility of disease reemergence and HEV viral transmission in LT patients.

多项研究已在包括泰国在内的多个地区的普通人群及肝移植术后（post-liver transplant, LT）人群中报道过极高的戊型肝炎（hepatitis E, HEV）血清阳性率，其中基因型3为主要流行基因型。本研究推测，HEV可能以亚临床状态持续存在，并在肝移植术后阶段带来临床风险。本研究纳入108名肝移植术后患者开展横断面研究，结果显示其HEV IgG（免疫球蛋白G）血清阳性率为55.6%。随后，本研究纳入91例无戊型肝炎相关肝炎临床证据的患者，开展为期1年的前瞻性随访，每4个月检测一次其临床状态、血清学指标及血清/粪便HEV RNA。研究检测到HEV RNA，提示血清学阳性或阴性患者均存在亚临床感染，年发生率为7.7%。本研究结果表明，在这一HEV高流行地区的肝移植术后患者中，确实存在亚临床HEV感染。因此，临床医师应警惕肝移植术后患者出现HEV感染复燃及病毒传播的可能性。