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. 2025 Mar 31;17(4):502.
doi: 10.3390/v17040502.

The Prevalence, Risk Factors, and Outcomes of Hepatitis E Virus Infection in Solid Organ Transplant Recipients in a Highly Endemic Area of Italy

Barbara Binda  1 , Giovanna Picchi  2   3 , Roberto Bruni  4 , Alessandro Di Gasbarro  5 , Elisabetta Madonna  4 , Umbertina Villano  4 , Giulio Pisani  6 , Alberto Carocci  6 , Cinzia Marcantonio  4 , Filippo Montali  7 , Alessandra Panarese  7 , Francesco Pisani  7 , Anna Rita Ciccaglione  4 , Enea Spada  4
Affiliations

The Prevalence, Risk Factors, and Outcomes of Hepatitis E Virus Infection in Solid Organ Transplant Recipients in a Highly Endemic Area of Italy

Barbara Binda et al. Viruses. .

Abstract

Hepatitis E virus (HEV) infection can become chronic in immunocompromised patients, like solid organ transplant recipients (SOTRs). We evaluated HEV prevalence, risk factors, and outcomes among SOTRs in a hyperendemic HEV area. Three hundred SOTRs were enrolled from April to July 2019 and tested for anti-HEV IgM and IgG and HEV RNA. Sixty-three recipients (21%) were positive for any HEV marker. HEV infection was independently associated with older age and pork liver sausage consumption. Three viremic recipients harbored genotype 3e and 3f according to HEV RNA sequencing and phylogenetic analysis. Overall, 10 recipients had markers of active/recent infection (HEV RNA and/or anti-HEV IgM) and were followed up prospectively. Five of them spontaneously resolved their HEV infection. In two recipients, HEV clearance was achieved only through immunosuppression reduction, while three needed ribavirin therapy to achieve virologic resolution. We observed a chronic course in 30% of SOTRs with active/recent HEV infection. No association was found between tacrolimus assumption and chronicization. In conclusion, we found a high prevalence of infection among SOTRs attending a transplant center in a hyperendemic Italian HEV region. Systematic screening for all HEV markers and dietary education for infection control are needed for transplant recipients.

Keywords: HEV; HEV genotypes; HEV–host interactions; antivirals.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Phylogenetic tree from the analysis of the HEV sequences from the three SOTR patients (red circles) together with sequences from HEV-positive cases detected during an outbreak in Abruzzo and Lazio in 2019 (blue circles) and subtype reference sequences of HEV genotype 3 (black circles); the suffix “Ref.SMITH” in the sequence name marks the references recommended by international expert agreement [29,30]. The three molecular clusters (A, B, and C) identified in the 2019 outbreak are shown [27].
Figure 2
Figure 2
Summary of serovirological results and infection evolution in HEV-infected patients.
See this image and copyright information in PMC

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