Program Schedule

437
Hepatitis E Virus Infection among Solid Organ Transplant recipients at a North American transplant center

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Hepatitis E Virus (HEV) is a leading cause of viral hepatitis worldwide, and is typically associated with flooding and poor sanitation.  Recently, HEV infection has been increasingly reported among solid organ transplant (SOT) recipients in industrialized nations.  In North America however, cases of HEV infection among SOT recipients remain rare despite a seroprevalence of 15-21%.

Methods: We conducted a retrospective, cross sectional study to investigate HEV infection among SOT recipients at our institution.  Post SOT sera collected between 1988 and 2012 were tested for HEV antibody using a PE-2 antigen based ELISA, and for HEV RNA by real time PCR. HEV antibody positive subjects were identified, and pre transplant samples then tested for HEV antibody.  Patients with evidence of HEV viremia, HEV IgG seroconversion or IgM positivity were considered recently infected, and serial samples were tested by PCR for evidence of chronic infection. 

Results:

A total of 314 (176F, 138M) subjects were tested for HEV antibody.  Samples were from 274 kidney, 33 lung, 5 cardiac, and 2 liver transplant recipients.  Mean age at time of transplant was 45.7 years (range 2Y-80Y), with 17 patients under 18 years of age.   Of 314 specimens, 59 (19%) were positive for HEV IgG antibody.  Sixteen subjects (5%) demonstrated evidence of recent HEV infection: two (0.6 %) subjects were positive for HEV IgM antibody, four (1%) had evidence of HEV viremia by PCR, and ten (3%) demonstrated HEV antibody sero-conversion after transplantation.

Mean ALT was 55 U/L among recently infected subjects, versus 47 U/L in the rest of the cohort (p=0.95).  Elevated ALT (>1.5x ULN) was noted in 46% of recently infected subjects versus 36% in the rest of the cohort (p=0.56).  Serial PCR of recently infected subjects yielded no further HEV RNA positive samples.

Conclusion:

We report 19% HEV IgG seroprevalence among SOT recipients in our cohort, and evidence of recent infection in 16/314 (5%) of subjects. Four patients (1%) had evidence of active HEV viremia.  No association was observed between recent HEV infection and acute hepatitis, and no cases of chronic HEV infection were identified. Further studies are needed to characterize the burden of HEV among SOT recipients in the United States.

Paul Sue, MDCM, FAAP1, Nora Pisanic, PhD2, Christopher Heaney, MS, PhD3, Kenrad Nelson, MD4, Kathleen Schwarz, MD5, Annette Jackson, PhD6, Robert Montgomery, MD7, John Ticehurst, MD8, Michael Forman, PhD9, Alexandra Valsamakis, MD, PhD9 and Wikrom Karnsakul, MD5, (1)Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (2)Epidemiology and Environmental Sciences, Johns Hopkins University School of Public Health, Baltimore, MD, (3)Epidemiology and Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, (4)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (5)Pediatric Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, (6)Immunogenetics, Johns Hopkins Medical Institutions, Baltimore, MD, (7)Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, (8)Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, (9)Johns Hopkins Medical Institutions, Baltimore, MD

Disclosures:

P. Sue, None

N. Pisanic, None

C. Heaney, None

K. Nelson, None

K. Schwarz, None

A. Jackson, None

R. Montgomery, None

J. Ticehurst, None

M. Forman, None

A. Valsamakis, None

W. Karnsakul, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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