B4(T)
HEPATITIS E IN RECIPIENTS OF RENAL TRANSPLANTS OR HAEMODIALYSIS
IN SOUTHWEST ENGLAND
Harrison, A1, Scobie, L4, Parry, R1, Johnston, P1, Stratton, J1, Dickinson, S1, Crossan, C²,
Bendall, R2,7, Ellis, V2,7, Grimes, D3, Parke, J3, Lin, N5, Henley, W5, Ijaz, S6, Dalton, H3,7
1
Department of Nephrology, 2Clinical Microbiology, 3Cornwall Gastrointestinal Unit,
Royal Cornwall Hospital Truro, Cornwall, 4Glasgow Caledonian University, Glasgow
5
Centre for Health and Environmental Statistics, University of Plymouth6Virus Reference
Department, Centre for Infections, Health Protection Agency, London7European Centre
for Environment & Human Health, Peninsula College of Medicine & Dentistry Truro
BACKGROUND: Locally-acquired Hepatitis E virus infection is increasingly recognised in
developed countries and has recently been shown to cause chronic infection with rapidly
progressive cirrhosis in solid-organ transplant recipients. It is unknown if HEV can cause
chronic infection in haemodialysis patients. Little is known about the HEV seroprevalence in
renal transplant or haemodialysis patients.
The aims of the current study were to document the prevalence of chronic HEV infection in
renal transplant recipients receiving immunosuppressive therapy and in patients with end stage
renal failure requiring haemodialysis, and to compare the anti-HEV seroprevalence in these
patients to a control population to determine if renal failure requiring haemodialysis or renal
transplantation were risk factors for HEV exposure.
METHODS: Serum samples from 88 patient with functioning renal transplants and 76 patients
receiving chronic haemodialysis were tested for HEV RNA and anti-HEV IgG and IgM.
Demographic, lifestyle, clinical and laboratory data were prospectively collected on each
patient. 670 controls were tested for anti-HEV IgG.
RESULTS: No patients tested positive for HEV RNA, excluding the possibility of chronic
infection. Anti-HEV IgG was positive in 28/76 (36.8%) of the haemodialysis and 16/88 (18.2%)
of transplant patients. 126/670 (18.8%) of control subjects were anti-HEV IgG positive and this
was positively associated with age (p<0.001). After adjusting for age and sex, there was a
significantly higher anti-HEV IgG seroprevalence amongst haemodialysis patients compared to
controls (OR=1.97, 95% CI=1.16-3.31, p=0.01) or transplant recipients (OR=2.63, 95%
CI=1.18-6.07, p=0.02). The duration of haemodialysis was not a significant risk factor for HEV
IgG positivity (p= 0.72). Patients with a functioning transplant showed no difference in antiHEV IgG seroprevalence compared to controls (p=0.6).
CONCLUSIONS: There is no evidence of chronic infection with HEV in renal transplant
recipients or patients receiving haemodialysis in Southwest England. Patients receiving
haemodialysis had a higher seroprevalence of anti-HEV IgG than either renal transplant
recipients or age- and sex-matched controls living in the same geographical area. There was no
association between duration of dialysis and likelihood of anti-HEV IgG seropositivity, and the
reasons underlying the difference in seroprevalence remain uncertain.