Eliminating viral hepatitis in children after liver transplants: How to reach the goal by 2030

Table 4 Studies of children infected with hepatitis E virus after liver transplantation

Ref.	Year	Country	Participants	Seroprevalence of HEV infection	Methods		Comments
					HEV IgM/G	HEV RNA
1[130]	2012	Canada	Gr 1; N: 66 with normal LFT, aged 13.7 yr (1.8-25.5); Gr 2; N: 14 with transaminitis, aged 17.4 yr (5.9-19.8)	Gr 1: 10/66 (15%) with IgG +, none had IgM, HEV RNA +; Gr 2: 12/14 (86%) with IgG+; 9/12 (75%) with IgM+; 1/12 (0.8%) with HEV RNA +	Feldan Bio Inc, Saint-Augustin	Serum nested RT-qPCR	All in Gr 2 showed a trend toward chronic hepatitis and fibrosis; An 8-yr-old girl had chronic HEV infection (genotype 3) for > 10 yr and developed cirrhosis
2[131]	2012	Germany	N: 41 liver-transplanted children, aged 8.8 ± 4.2 yr	2/41 (4.9%) IgG +0/41 stool HEV RNA +	Mikrogen	Stool RT-qPCR	No case with chronic HEV infection
3[132]	2013	Germany	N: 22 liver-transplanted children, aged 6.7 yr (1.4-17.2)	1/22 (0.45%) IgG + by Wantai assay and HEV RNA + in serum	Wantai assay	Serum or stool PCR	10-year-old boy with HEV infection that had persistent transaminitis after 2-mo immunosuppressive reduction. Ribavirin 15 mg/kg/d was started for 6 mo. Normal LFT and undetectable serum and stool HEV RNA at day 42 of treatment.
4[139]	2014	Brazil	One liver-transplanted child: case report	HEV IgG/IgM and HEV RNA in serum and liver tissue at 6-10 yr after liver transplantation	Mikrogen	Liver and serum RT-PCR	A 4-yr-old girl with transaminitis from ACR at 6 yr after LT, had transaminitis off and on and HEV IgG/IgM and HEV RNA was detected 9-10 yr after LT. Chronic HEV infection was successful treatment with ribavirin for 10 mo.
5[133]	2015	France	84 liver-transplanted children, aged 12.3 yr	8/84 (8.3%) HEV IgG+	Wantai assay	Ceeram Tools® kit for HEV-RNA detection	None had HEV IgM/RNA +; No case of chronic infection
6[140]	2020	France	80 liver-transplanted children, aged 3.5 ± 4 yr	6/80 (8%) with HEV IgG+	Wantai assay	Ceeram Tools® kit for HEV-RNA detection	None had HEV IgM/RNA +; No case of chronic infection; 4/6 had undetectable HEV IgG after follow-up (3-42 mo)
7	2021	Thailand	30 liver-transplanted children with transaminitis, aged 1.2-17.6 yr	14/30 (45.2%) with HEV IgG+, 4 (13%) with HEV IgM+ and one case with HEV RNA in stool	Euroimmun kit	Stool PCR	All of them had persistence of HEV IgM from 5 to 44 mo and transaminitis from 4 to 30 mo before HEV testing. The previous treatment included graft rejection, de novo autoimmune hepatitis and CMV viremia.

Ref: Reference; Gr: Group; RT-qPCR: Real-time polymerase chain reaction; HEV: Hepatitis E virus; ACR: Acute cellular rejection; MP: MP Biomedicals, formerly Genelabs Diagnostics, Singapore; Wantai assay: Wantai Biologic Pharmacy Enterprise, Beijing, China; LT: Liver transplantation; CMV: Cytomegalovirus.