*Purpose: Hepatitis E virus (HEV) infection is an underdiagnosed disease due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with preexisting chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in in decompensated liver disease and death. The prevalence of HEV infection in solid organ transplant recipients is unknown and varies among organ types.

*Methods: We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria are adult patients with history of solid organ transplantation. HEV infection is confirmed by either HEV-IgG, HEV-IgM, or HEV RNA assay.

*Results: Of 563 citations, a total of 22 studies (n = 4,557) were included in the meta-analysis. The pooled estimated prevalence of HEV infection among solid organ transplant patients was 20.2% (95% CI 14.9-26.8). The pooled estimated prevalence of HEV infection in each organ transplant was as followed: liver (27.2%; 95% CI 20.0-35.8), kidney (12.8%; 95% CI 9.3-17.3), heart (12.8%; 95% CI 9.3-17.3), and lung (5.6%; 95% CI 1.6-17.9). The comparison across all organ transplant was statistically significant (Q = 16.721, p = 0.002). There was no statistical significance across subgroup analyses. The pooled estimated prevalence of de novo HEV infection was 5.1% (95% CI 2.6-9.6) and the pooled estimated prevalence of acute HEV infection was 4.3% (95% CI 1.9-9.4).

*Conclusions: HEV infection is common in solid organ transplant recipients. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies demonstrating the clinical impacts of HEV infection in solid organ transplant recipients, such as graft failure, rejection, and mortality, are warranted.

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