The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
- Serological positive samples were available from a previous study carried out with HIV-infected patients [16].
- HEV RNA positive samples were available from a previous study carried out with pigs. These pig viruses were characterized as subtypes 3c and 3f, which have also been found in human samples [17].
- To be sure that our technique was good to detect HEV in humans, we have ordered the “1st World Health Organization International Standard for Hepatitis E Virus RNA Nucleic Acid Amplification Techniques (NAT)-Based Assays”, a genotype 3a strain of HEV, derived from the plasma of a blood donor [18] and also genotypes 3c and 3f strains bought at that time from Qnostics Ltd. (Glasgow, Scotland, UK). After all the protocols proposed by the College of American Pathology, the technique was implemented in the routine with an analytical sensitivity of 50 UI/mL and an accuracy of 100% using the available positive and negative samples.
- For the first assays, the positive controls were those described above, and up to the moment we obtained a very strong positive sample that was also submitted to a full-length sequence and confirmed as HEV genotype 3f.
2.2. Definitions
- HEV infection: anti-HEV IgM positivity, anti-HEV IgG positivity, or positivity for HEV on qRT-PCR.
- Primary HEV infection: anti-HEV IgM positivity, anti-HEV IgG positivity, or positivity for HEV on qRT-PCR in a patient previously testing negative for anti-HEV IgG or IgM antibodies.
- Chronic HEV infection: positivity for HEV on qRT-PCR for a period of three months or more.
- Acute hepatitis: increase to at least double the normal value in the concentrations of the hepatic transaminases alanine aminotransferase (ALT) and aspartate aminotransferase or of the canalicular enzymes gamma-glutamyl transferase and alkaline phosphatase.
2.3. Serology
2.4. HEV RNA Detection
2.5. Statistical Analysis
2.6. Ethical Aspects
3. Results
3.1. HEV Infection in the Pretransplant Period
3.2. Positive Anti-HEV IgG Receptors in Pretransplant
3.3. Anti-HEV IgG-Positive Donors
3.4. HEV RNA
3.5. Comparison between Anti-HEV IgG Positive and Negative Recipients
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | (N = 107) |
---|---|
Age (years), mean ± SD | 53.5 ± 13.13 |
Male, n (%) | 78 (72.9) |
More than one underlying disease, n (%) | 44 (41.1) |
Underlying disease, n (%) | |
Alcoholic liver cirrhosis | 34 (31.8) |
Chronic hepatitis C | 24 (22.4) |
Cryptogenic cirrhosis | 15 (14.0) |
Autoimmune hepatitis | 9 (8.4) |
Non-alcoholic steatohepatitis | 7 (6.5) |
Other | 18 (16.8) |
Region of birth, n (%) | |
Southeastern Brazil | 77 (72.0) |
Northeastern Brazil | 23 (21.5) |
Central-west Brazil | 3 (2.8) |
Southern Brazil | 2 (1.9) |
Northern Brazil | 1 (0.9) |
Region of residence, n (%) | |
Southeastern Brazil | 101 (94.4) |
Central-west Brazil | 4 (3.7) |
Northeastern Brazil | 2 (1.9) |
Resident of an urban area, n (%) | 103 (96.3) |
Level of education, n (%) | |
None | 1 (1.0) |
<9 years of schooling | 18 (17.1) |
9 years of schooling | 11 (10.4) |
High school, incomplete | 5 (4.8) |
High school, complete | 36 (34.3) |
College, incomplete | 12 (11.4) |
College, complete | 21 (20.0) |
Postgraduate work | 1 (1.0) |
Previous blood transfusion, n (%) | 56 (52.3) |
Consumption of pork, n (%) | 89 (83.2) |
Consumption of game meat, n (%) | 40 (37.4) |
Consumption of seafood, n (%) | 79 (73.8) |
Home with sewage system, n (%) | 105 (98.1) |
Home with treated water, n (%) | 105 (98.1) |
Contact with domestic animals, n (%) | 56 (52.3) |
Contact with natural waters, n (%) | 55 (51.4) |
Previous contact with an HEV-infected individual, n (%) | 2 (1.9) |
Travel in the last year, n (%) | 50 (46.7) |
Anti-HEV IgG-positive, n (%) | 11 (10.3) |
Anti-HEV IgM-positive, n (%) | 1 (0.9) |
Characteristic | HEV IgG + (n = 11) | HEV IgG − (n = 96) | p-Value | ||
---|---|---|---|---|---|
Male, n (%) | 10 | (91%) | 68 | (71%) | 0.156 |
Age (years), mean ± SD | 57 | (13.5) | 53 | (7.9) | 0.338 |
Region of birth, n (%) | |||||
Southeastern Brazil | 6 | (55%) | 71 | (75%) | 0.230 |
Northeastern Brazil | 4 | (37%) | 19 | (20%) | |
Central-west Brazil | 0 | (0%) | 3 | (3%) | |
Southern Brazil | 1 | (8%) | 1 | (1%) | |
Northern Brazil | 0 | (0%) | 1 | (1%) | |
Region of residence, n (%) | |||||
Southeastern Brazil | 10 | (91%) | 91 | (95%) | 0.143 |
Central-west Brazil | 0 | (0%) | 4 | (4%) | |
Southern Brazil | 1 | (9%) | 1 | (1%) | |
Resident of an urban area, n (%) | 11 | (100%) | 92 | (96%) | 1.0 |
>9 years of schooling | 6 | (45%) | 69 | (73%) | 0.190 |
Underlying disease, n (%) | |||||
Chronic hepatitis C | 1 | (9%) | 23 | (24%) | 0.182 |
Alcoholic liver cirrhosis | 6 | (55%) | 21 | (22%) | |
Cryptogenic cirrhosis | 1 | (9%) | 14 | (15%) | |
Non-alcoholic steatohepatitis | 0 | (0%) | 7 | (7%) | |
Other | 3 | (27%) | 31 | (32%) | |
More than one underlying disease, n (%) | 4 | (46%) | 40 | (42%) | 0.735 |
Previous blood transfusion, n (%) | 5 | (45%) | 51 | (54%) | 0.580 |
Consumption of pork, n (%) | 9 | (82%) | 80 | (85%) | 0.774 |
Consumption of game meat, n (%) | 6 | (55%) | 34 | (36%) | 0.235 |
Consumption of seafood, n (%) | 7 | (64%) | 72 | (77%) | 0.346 |
Home with sewage system, n (%) | 11 | (100%) | 94 | (99%) | 1.0 |
Home with treated water, n (%) | 11 | (100%) | 94 | (99%) | 1.0 |
Contact with domestic animals, n (%) | 3 | (27%) | 53 | (57%) | 0.107 |
Contact with natural waters, n (%) | 5 | (45%) | 50 | (54%) | 0.752 |
Previous contact with an HEV-infected individual, n (%) | 0 | (0%) | 2 | (2%) | 1.0 |
Travel in the last year, n (%) | 3 | (27%) | 47 | (51%) | 0.144 |
Retransplant | 0 | (0%) | 5 | (5%) | 1.0 |
1-year survival | 10 | (91%) | 86 | (90%) | 0.891 |
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Zicker, M.; Pinho, J.R.R.; Welter, E.A.R.; Guardia, B.D.; da Silva, P.G.T.M.; da Silveira, L.B.; Camargo, L.F.A. The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study. Viruses 2024, 16, 301. https://doi.org/10.3390/v16020301
Zicker M, Pinho JRR, Welter EAR, Guardia BD, da Silva PGTM, da Silveira LB, Camargo LFA. The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study. Viruses. 2024; 16(2):301. https://doi.org/10.3390/v16020301
Chicago/Turabian StyleZicker, Michelle, João R. R. Pinho, Eliane A. R. Welter, Bianca D. Guardia, Paulo G. T. M. da Silva, Leonardo B. da Silveira, and Luís F. A. Camargo. 2024. "The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study" Viruses 16, no. 2: 301. https://doi.org/10.3390/v16020301
APA StyleZicker, M., Pinho, J. R. R., Welter, E. A. R., Guardia, B. D., da Silva, P. G. T. M., da Silveira, L. B., & Camargo, L. F. A. (2024). The Risk of Reinfection or Primary Hepatitis E Virus Infection at a Liver Transplant Center in Brazil: An Observational Cohort Study. Viruses, 16(2), 301. https://doi.org/10.3390/v16020301