Background: In recent years several reports suggest that acute and chronic hepatitis E virus (HEV) infection may complicate the course after both solid-organ (SOT) and hematopoietic stem cell (HSCT) transplantation. We have previously reported that ALT-flares occur frequently in transplant-recipients and multiple episodes were associated with excess risk of death (adjusted incidence rate ratio for >2 versus no ALT-flares=5.1 (3.2-8.1), p>0.0001). Underlying reason for the ALT-flares was only known for a fraction. While patients experienced on-going ALT-flares, we assumed that the chance of detecting HEV RNA was most optimal, and prevalence of acute and chronic HEV infection is reported here.
Methods: Analysis included 1002 SOT (kidney (n=328), liver (170), lung (120), and heart (47)) and HSCT (337) recipients at our hospital, all consecutively transplant between September 2009 and July 2013. All available plasma samples collected during periods of ongoing ALT-flares were screened for the detection of HEV RNA (Grifols Procleix " HEV) [95% detection probability in pools of five: 39.5 IU/ml].
Results: 502 of 1002 patients experienced >1 ALT-flare (total number of ALT-flares 1197). The underlying reason for ALT-flares were often unknown (50%), due to infection (12%), drug-induced-liver-injury (DILI) (11%) or other reasons. Among 215 of the 502 (43%) recipients a total of 661 plasma samples taken during 487 individual ALT-flares were screened for presence of HEV RNA, and one positive sample was detected. Additional examination of other available samples suggested that the person was acutely infected prior to the transplantation, but had spontaneously cleared the infection when experiencing the next post-transplant ALT-flare (Figure).
Conclusion: Whereas ALT-flares often develop during the post-transplant course in approximately 50% of transplant recipients, and develops mostly for unknown reasons, HEV infection is a rare cause of these ALT-flares. Therefore, our data suggest that primary routine screening for HEV is not indicated to investigate the cause of ALT-flares after transplantation. Also, as multiple ALT-flares are associated with excess mortality, concerted action is required to identify other ALT-flare inducing factors than HEV.
H. Ullum, None
A. Mocroft, None
C. Da Cunha-Bang, None
N. Kirkby, None
S. Schwartz Sørensen, None
J. Lundgren, None
M. Iversen, None
A. Rasmussen, None
F. Gustafsson, None
H. Sengeløv, None
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