Hepatitis E Infection in Solid Organ Transplant Recipients in Turkey

Background: Hepatitis E virus (HEV) is a re-emerging pathogen with an increase in human cases that can lead to chronic infection in immunosuppressed patients. Turkey is located between Asia and Europe, two regions with distinct epidemiological and clinical features of HEV infection. This multicenter cross-sectional study aimed to investigate the prevalence of HEV infection in liver and kidney transplant recipients in Turkey and to determine the role of possible transmission factors.  Methods: A total of 485 plasma samples of solid organ recipients were collected from seven transplantation centers in Turkey.  Samples were tested for anti-HEV IgM, IgG and HEV RNA.  Water and food-related risk factors were evaluated by a questionnaire. Results: Samples of 300 kidney and 185 liver recipients were collected. HEV RNA has tested in 472 samples and none were positive. Anti-HEV IgG and IgM were detected in 84 (17.3%) and 3 (%0.6) patients. Seropositivity was associated with older age, male gender, being a liver recipient and infected with HBV and/or HCV.  None of the patients under the age of 30 were seropositive. HEV IgG prevalence was higher in the central-east and southeast Anatolia. Eating raw meat was the only independent variable associated with HEV seropositivity.  Conclusion: This is the first prevalence study of HEV infection in solid organ recipients in Turkey. Anti-HEV IgG prevalence was 17.3% which was higher than the previously reported rate in blood donors. Seropositivity was significantly higher in liver recipients.  Despite the high antibody prevalence, none of the patients were viremic.