Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2021; 27(12): 1240-1254
Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1240
Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis
Panupong Hansrivijit, Angkawipa Trongtorsak, Max M Puthenpura, Boonphiphop Boonpheng, Charat Thongprayoon, Karn Wijarnpreecha, Avishek Choudhury, Wisit Kaewput, Shennen A Mao, Michael A Mao, Caroline C Jadlowiec, Wisit Cheungpasitporn
Panupong Hansrivijit, Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
Angkawipa Trongtorsak, Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, IL 60202, United States
Max M Puthenpura, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, United States
Boonphiphop Boonpheng, David Geffen School of Medicine, University of California, Los Angeles, Division of Nephrology, Los Angeles, CA 90095, United States
Charat Thongprayoon, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Karn Wijarnpreecha, Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, FL 32224, United States
Avishek Choudhury, School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ 07030, United States
Wisit Kaewput, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Shennen A Mao, Department of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, United States
Michael A Mao, Department of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
Caroline C Jadlowiec, Department of Transplant Center, Mayo Clinic, Scottsdale, AZ 85259, United States
Wisit Cheungpasitporn, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Hansrivijit P, Trongtorsak A, Puthenpura MM, Boonpheng B and Thongprayoon C performed acquisition of data; Hansrivijit P, Trongtorsak A, Puthenpura MM and Boonpheng B drafted the article; Hansrivijit P performed analysis and interpretation of data; Trongtorsak A performed analysis of data; Wijarnpreecha K, Choudhury A, Kaewput W, Mao SA, Mao MA, Jadlowiec CC and Cheungpasitporn W performed interpretation of data, revising the article; all authors were involved in the final approval.
Conflict-of-interest statement: The authors declared no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wisit Cheungpasitporn, FACP, Assistant Professor, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, United States.wcheungpasitporn@gmail.com
Received: December 19, 2020
Peer-review started: December 19, 2020
First decision: January 10, 2021
Revised: January 17, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: March 28, 2021
Abstract
BACKGROUND

Hepatitis E virus (HEV) infection is underdiagnosed due to the use of serological assays with low sensitivity. Although most patients with HEV recover completely, HEV infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death.

AIM

To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients.

METHODS

We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through October 2020. The inclusion criteria consisted of adult patients with history of SOT. HEV infection is confirmed by either HEV-immunoglobulin G, HEV-immunoglobulin M, or HEV RNA assay.

RESULTS

Of 563 citations, a total of 22 studies (n = 4557) were included in this meta-analysis. The pooled estimated prevalence of HEV infection in SOT patients was 20.2% [95% confidence interval (CI): 14.9-26.8]. The pooled estimated prevalence of HEV infection for each organ transplant was as follows: 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). Comparison across organ transplants demonstrated statistical significance (Q = 16.721, P = 0.002). The subgroup analyses showed that the prevalence of HEV infection among SOT recipients was significantly higher in middle-income countries compared to high-income countries. 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).

CONCLUSION

HEV infection is common in SOT recipients, particularly in middle-income countries. The prevalence of HEV infection in lung transplant recipients is considerably less common than other organ transplants. More studies examining the clinical impacts of HEV infection in SOT recipients, such as graft failure, rejection, and mortality are warranted.

Keywords: Hepatitis E virus, Hepatitis E virus infection, Solid organ transplant, Prevalence

Core Tip: Hepatitis E virus (HEV) infection among patients with pre-existing chronic liver disease and organ-transplant recipients on immunosuppressive therapy can result in decompensated liver disease and death. The prevalence of HEV infection in solid organ transplant (SOT) recipients varies by countries and transplanted organs. This meta-analysis, demonstrates the prevalence of HEV infection in SOT recipients is 20.3% (highest in liver transplant recipients and lowest in lung transplant recipients). The prevalence of HEV infection is two-fold more common in middle-income countries compared to high-income countries. Our findings encourage future studies to describe the clinical impacts of HEV infection on patient and allograft outcomes.