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Abstract

INTRODUCTION: In solid organ transplant (SOT) recipients, hepatitis E virus (HEV) poses a complex clinical challenge, because there is a risk of developing persistent infection. Current European guidelines recommend the screening of HEV in SOT recipients because of the risk of unrecognised infection. Despite these recommendations, routine screening for HEV remains underutilised in clinical practice.

AIM: Our study aimed to determine the prevalence of HEV viraemia and to evaluate the clinical evolution of HEV infection in SOT.

METHODS: We performed a multicentre cross-sectional study including adult SOT recipients under follow-up in Spain. All patients were prospectively tested for HEV RNA in peripheral blood. Individuals with detectable viraemia were prospectively followed up every 3 months to evaluate viral persistence.

RESULTS: A total of 940 patients were included in the study. Five patients were infected, supposing a prevalence of HEV infection in Spanish SOT recipients of 0.53% (95% confidence interval: 0.23–1.24). Genotyping was successfully conducted in four cases, all identified as genotype 3. All patients were asymptomatic and had varied levels of liver enzyme elevations. At follow-up, three of the five patients remained HEC RNA-positive, consistent with chronic infection. Overall, the prevalence of chronic HEV infection in our study population was 0.32%.

CONCLUSION: Our study highlights the need to establish periodic molecular HEV surveillance in SOT recipients.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2025-11-06
2026-04-15
/content/10.2807/1560-7917.ES.2025.30.44.2500254
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References

  1. Ouyang G, Pan G, Li Q, Li S, Liu T, Yi X, et al. Global burden of acute hepatitis E between 1990 and 2019 and projections until 2030. Liver Int. 2024;44(6):1329-42.  https://doi.org/10.1111/liv.15883  PMID: 38426633 
  2. World Health Organization (WHO). Global hepatitis report 2017. Geneva: WHO; 2017. 83 p. Available from: https://iris.who.int/handle/10665/255016
  3. Bagulo H, Majekodunmi AO, Welburn SC. Hepatitis E in Sub Saharan Africa - A significant emerging disease. One Health. 2020;11:100186.  https://doi.org/10.1016/j.onehlt.2020.100186  PMID: 33204807 
  4. Ricci A, Allende A, Bolton D, Chemaly M, Davies R, Fernandez Escamez PS, et al. Public health risks associated with hepatitis E virus (HEV) as a food-borne pathogen. EFSA J. 2017;15(7):e04886. PMID: 32625551 
  5. Kamar N, Izopet J, Pavio N, Aggarwal R, Labrique A, Wedemeyer H, et al. Hepatitis E virus infection. Nat Rev Dis Primers. 2017;3(1):17086.  https://doi.org/10.1038/nrdp.2017.86  PMID: 29154369 
  6. Vento S, Cainelli F. Acute liver failure in low-income and middle-income countries. Lancet Gastroenterol Hepatol. 2023;8(11):1035-45.  https://doi.org/10.1016/S2468-1253(23)00142-5  PMID: 37837969 
  7. Pischke S, Hartl J, Pas SD, Lohse AW, Jacobs BC, Van der Eijk AA. Hepatitis E virus: Infection beyond the liver? J Hepatol. 2017;66(5):1082-95.  https://doi.org/10.1016/j.jhep.2016.11.016  PMID: 27913223 
  8. Ma Z, de Man RA, Kamar N, Pan Q. Chronic hepatitis E: Advancing research and patient care. J Hepatol. 2022;77(4):1109-23.  https://doi.org/10.1016/j.jhep.2022.05.006  PMID: 35605741 
  9. Dalton HR, Kamar N, Baylis SA, Moradpour D, Wedemeyer H, Negro F, et al. EASL clinical practice guidelines on hepatitis E virus infection. J Hepatol. 2018;68(6):1256-71.  https://doi.org/10.1016/j.jhep.2018.03.005  PMID: 29609832 
  10. McPherson S, Elsharkawy AM, Ankcorn M, Ijaz S, Powell J, Rowe I, et al. Summary of the British Transplantation Society UK guidelines for hepatitis E and solid organ transplantation. Transplantation. 2018;102(1):15-20.  https://doi.org/10.1097/TP.0000000000001908  PMID: 28795981 
  11. European Directorate for the Quality of Medicines & HealthCare (EDQM). Guide to the quality and safety of organs for transplantation. Strasbourg: EDQM. [Accessed: 6 Apr 2025]. Available from: https://www.edqm.eu/en/guide-quality-and-safety-of-organs-for-transplantation
  12. Ankcorn MJ, Tedder RS, Cairns J, Sandmann FG. Cost-effectiveness analysis of screening for persistent hepatitis e virus infection in solid organ transplant patients in the United Kingdom: A model-based economic evaluation. Value Health. 2020;23(3):309-18.  https://doi.org/10.1016/j.jval.2019.09.2751  PMID: 32197726 
  13. Reekie I, Irish D, Ijaz S, Fox T, Bharucha T, Griffiths P, et al. Hepatitis E infection in stem cell and solid organ transplant patients: A cross-sectional study: The importance of HEV RNA screening in peri-transplant period. J Clin Virol. 2018;107:1-5.  https://doi.org/10.1016/j.jcv.2018.07.011  PMID: 30099145 
  14. Ankcorn MJ, Ijaz S, Poh J, Elsharkawy AM, Smit E, Cramb R, et al. Toward systematic screening for persistent hepatitis E virus infections in transplant patients. Transplantation. 2018;102(7):1139-47.  https://doi.org/10.1097/TP.0000000000002097  PMID: 29953421 
  15. Frías M, López-López P, Zafra I, Caballero-Gómez J, Machuca I, Camacho Á, et al. Development and clinical validation of a pangenotypic PCR-based assay for the detection and quantification of hepatitis E Virus (Orthohepevirus A genus). J Clin Microbiol. 2021;59(2):e02075-20.  https://doi.org/10.1128/JCM.02075-20  PMID: 33148702 
  16. Guerrero-Vadillo M, Peñuelas M, Carmona R, León-Gómez I, Varela C. Increasing trends in hepatitis E hospitalisations in Spain, 1997 to 2019. Euro Surveill. 2024;29(43):2400118.  https://doi.org/10.2807/1560-7917.ES.2024.29.43.2400118  PMID: 39450516 
  17. Toh HJ, Lim ZY, Yap P, Tang T. Factors associated with prolonged length of stay in older patients. Singapore Med J. 2017;58(3):134-8.  https://doi.org/10.11622/smedj.2016158  PMID: 27609507 
  18. Kamar N, Garrouste C, Haagsma EB, Garrigue V, Pischke S, Chauvet C, et al. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology. 2011;140(5):1481-9.  https://doi.org/10.1053/j.gastro.2011.02.050  PMID: 21354150 
  19. Pischke S, Stiefel P, Franz B, Bremer B, Suneetha PV, Heim A, et al. Chronic hepatitis e in heart transplant recipients. Am J Transplant. 2012;12(11):3128-33.  https://doi.org/10.1111/j.1600-6143.2012.04200.x  PMID: 22823202 
  20. Harritshøj LH, Hother CE, Sengeløv H, Daugaard G, Sørensen SS, Jacobsen S, et al. Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients. Int J Infect Dis. 2020;91:188-95.  https://doi.org/10.1016/j.ijid.2019.11.014  PMID: 31756566 
  21. Sinakos Ε, Gioula G, Liava C, Papa A, Papadopoulou E, Tsakni E, et al. Prevalence of hepatitis E in liver transplant recipients in Greece. Epidemiol Infect. 2018;146(13):1619-21.  https://doi.org/10.1017/S0950268818001887  PMID: 29974836 
  22. Pas SD, de Man RA, Mulders C, Balk AH, van Hal PT, Weimar W, et al. Hepatitis E virus infection among solid organ transplant recipients, the Netherlands. Emerg Infect Dis. 2012;18(5):869-72.  https://doi.org/10.3201/eid1805.111712  PMID: 22516170 
  23. Samala N, Wang RY, Auh S, Balla AK, Dakhoul L, Alter HJ, et al. Hepatitis E prevalence and infection in solid-organ transplant recipients in the United States. J Viral Hepat. 2022;29(12):1134-42.  https://doi.org/10.1111/jvh.13739  PMID: 36036116 
  24. Rivero-Juárez A, Aguilera A, Avellón A, García-Deltoro M, García F, Gortazar C, et al. Executive summary: Consensus document of the diagnosis, management and prevention of infection with the hepatitis E virus: Study Group for Viral Hepatitis (GEHEP) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin (Engl Ed). 2020;38(1):28-32.  https://doi.org/10.1016/j.eimce.2018.06.014  PMID: 30072282 
  25. Abravanel F, Dimeglio C, Castanier M, Péron JM, Kamar N, Lhomme S, et al. Does HEV-3 subtype play a role in the severity of acute hepatitis E? Liver Int. 2020;40(2):333-7.  https://doi.org/10.1111/liv.14329  PMID: 31837187 
  26. Baylis SA, Adlhoch C, Childs L, Stühler A, Karlsson M, Molier M, et al. An evaluation of hepatitis E virus molecular typing methods. Clin Chem. 2021;68(1):181-91.  https://doi.org/10.1093/clinchem/hvab186  PMID: 34969109 
Hepatitis E virus screening in solid organ transplant recipients: prevalence and implications for implementation, Spain, 2021 to 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sara+Pereira&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pereira Sara</a>, <a href="/search?value1=Alfredo+P%C3%A9rez-Rivilla&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pérez-Rivilla Alfredo</a>, <a href="/search?value1=Raquel+Carracedo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carracedo Raquel</a>, <a href="/search?value1=Pedro+L%C3%B3pez-L%C3%B3pez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">López-López Pedro</a>, <a href="/search?value1=Manuel+Rodr%C3%ADguez-Iglesias&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rodríguez-Iglesias Manuel</a>, <a href="/search?value1=Rafael+Benito&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benito Rafael</a>, <a href="/search?value1=Ana+Fuentes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fuentes Ana</a>, <a href="/search?value1=Miguel+%C3%81ngel+L%C3%B3pez-Ruz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">López-Ruz Miguel Ángel</a>, <a href="/search?value1=Carolina+Freyre-Carrillo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Freyre-Carrillo Carolina</a>, <a href="/search?value1=Mar%C3%ADa+Del+Valle+Odero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Del Valle Odero María</a>, <a href="/search?value1=Noelia+Paraj%C3%B3&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Parajó Noelia</a>, <a href="/search?value1=Federico+Garc%C3%ADa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">García Federico</a>, <a href="/search?value1=Antonio+Rivero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rivero Antonio</a>, <a href="/search?value1=Antonio+Rivero-Ju%C3%A1rez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rivero-Juárez Antonio</a>, <a href="/search?value1=Antonio+Aguilera&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aguilera Antonio</a></span>. Hepatitis E virus screening in solid organ transplant recipients: prevalence and implications for implementation, Spain, 2021 to 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(44):pii=2500254. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.44.2500254" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.44.2500254</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 08 Apr 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 17 Jun 2025 </span> </p>
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