Epidemiology and natural history of hepatitis E virus in liver transplantation.

Abstract

Hepatitis E virus infection (HEV) is a worldwide emerging public health problem. It infects about 20 million people and causes 70,000 deaths every year. Anti-HEV antibodies have been detected in 5-30% of the general population in developing countries but lower prevalences are reported in industrialized countries. HEV is mainly an enterically transmitted pathogen although other routes of transmission including zoonotic food borne, blood borne and perinatal mother-to-child have been documented. This virus was initially thought to only cause acute infection, but chronic infection was described in organ transplant recipients, in patients with hematological malignancies and in human immunodeficiency virus-infected patients. Progression of chronic hepatitis E to cirrhosis and extrahepatic manifestations have been observed in liver transplant recipients. The incidence and seroprevalence of hepatitis E in liver transplantation scenario varies according to the studied population, the type of transplantation and the laboratory methodology employed. Most studies published so far have been performed in developed countries. A Brazilian study reported HEV positive biomarkers in up to 23% of kidney transplant recipients. Considering the economic, social and educational differences of the Brazilian population, it becomes necessary to investigate the prevalence, incidence, route of transmission and the natural history of the hepatitis E virus infection, especially in highly vulnerable populations such as liver transplant recipients. Thus, the present project proposes a prospective study of hepatic transplant recipients from Hospital Israelita Albert Einstein in São Paulo, Brazil. Systematic periodic testing for anti-HEV antibodies, polymerase chain reaction (PCR) for HEV and virus genotyping will be carried out before and for a period of one year after the liver transplantation. (AU)