Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1240
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
Processing time: 95 Days and 15.1 Hours
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.
To demonstrate the prevalence of HEV infection in solid organ transplant (SOT) recipients.
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.
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).
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.
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.