Aim. To determine the prevalence of HEV infection in kidney candidates and assess chronic HEV infection among transplant recipients. Methods. We recruited 244 kidney transplant candidates at our center from 2/1/2014 to 1/31/2015. Testing for anti-HEV IgM and IgG (DS-AB Diagnostic Systems GmbH, Germany) and for HEV RNA (LDT, US CDC Atlanta) were performed on sera from all candidates pre-transplant, in 100 of 104 candidates transplanted during the study at 1, 3, 6 and 12 months post-operatively; and from donors for 68 of those recipients transplanted. With each blood test, all patients were interviewed about exposure to specific HEV risk factors in the preceding 3 months. Results. Eighteen percent of the entire cohort were anti-HEV IgG positive at baseline. Anti-HEV IgG prevalence increased with age (p=0.0006), while other demographic factors (gender, ethnicity, place of birth), medical history (dialysis status, prior organ transplant, diabetes, co-infection with hepatitis B, C or HIV) and recent exposure to HEV risk factors were not significantly associated. In patients tested pre-and post-transplant (n=100), the prevalence of anti-HEV IgG increased from 19% to 25% (p=0.07), respectively; there was no significant change in IgM positivity (p=0.62) and no recipients tested positive for HEV RNA after transplant. No risk factors for HEV were reported by post-transplant seroconverters. Among the 68 donor-recipient pairs with available donor serologies, 8 HEV-seronegative recipients were transplanted from HEV-seropositive donors. None of these 8 recipients seroconverted on follow-up. In summary, among kidney transplant candidates, prevalence of anti-HEV IgG increases with age, and it is higher than reported in the general population; in recipients, anti-HEV seropositivity increased within the first 12 post-transplant months, though there was no evidence of chronic or transient viremia. Limited data suggest that presence of anti-HEV IgG and/or anti-HEV IgM in donors, in the absence of HEV RNA, does not appear to be associated with HEV transmission to kidney recipients. Conclusion. Prevalence of HEV infection in advanced chronic kidney disease patients is higher than reported in the general population but, unlike the European experience, does not appear to cause significant morbidity before or after transplant in the northeast US.

CITATION INFORMATION: Lim M, Kamili S, Greene T, Tejada-Strop A, Drobeniuc J, Vanderveen M, Bloom R. Hepatitis E Virus (HEV) Infection Among Kidney Transplant Patients in a Northeast US Center. Am J Transplant. 2016;16 (suppl 3).

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