Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis
Panupong Hansrivijit, Angkawipa Trongtorsak, Max Puthenpura, Boonphiphop Boonpheng, Charat Thongprayoon, Karn Wijarnpreecha, Avishek Choudhury, Wisit Kaewput, Shennen A. Mao, Michael A. Mao, Caroline C. Jadlowiec, Wisit Cheungpasitporn
Abstract
BACKGROUND: Hepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death. AIM: To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients. METHODS: We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay. RESULTS: = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. The pooled estimated prevalence of de novo HEV infection was 5.1% (95%CI: 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95%CI: 1.9-9.4). CONCLUSION: HEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.