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（LT）术后人群中报告了较高的戊型肝炎病毒（HEV）血清阳性率，其中3型基因型为主要流行株。本研究假设，戊型肝炎病毒（HEV）可在肝移植术后人群中以亚临床状态持续存在，并可能带来临床风险。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IgG抗体血清阳性率为55.6%。随后，我们纳入91例无戊型肝炎相关性肝炎临床证据的患者，开展为期1年的前瞻性随访，每4个月对其临床状态、血清学指标及血清/粪便HEV RNA进行检测。研究检出HEV RNA，提示无论血清学阳性与否，患者均存在亚临床感染，年发病率为7.7%。本研究结果证实，在这一戊型肝炎病毒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戊型肝炎复燃及病毒传播的风险。