Abstract
Background
Hepatitis E virus (HEV) infection is highly endemic in India, being the most common cause of acute hepatitis; however, no case of chronic infection has been reported. All the human isolates of HEV from India till date have belonged to genotype 1. In contrast, in non-endemic areas, genotype 3 is the most prevalent, and persistent HEV infection has been reported among solid-organ transplant recipients. Whether persistent infection occurs with genotype 1 HEV is unclear. We therefore looked for evidence of HEV infection among renal transplant recipients with elevated alanine transaminase (ALT).
Methods
Renal transplant recipients receiving immunosuppressive therapy were screened for ALT levels, irrespective of time duration since renal transplant. For those with ALT levels equal to or exceeding 50 IU/mL on at least two occasions ≥3 weeks apart, serum was tested for HEV RNA using a sensitive real-time reverse transcription polymerase chain reaction assay. For those testing positive, HEV genotyping and follow up for duration of viral persistence were planned.
Results
Of the 275 patients studied, 49 (17.8 %, 44 male, median age = 39.5 years) had elevated ALT levels (median = 62 [range = 50–477] IU/L). None of these 49 patients had detectable HEV RNA in the serum using an assay with detection sensitivity of 300 copies of RNA/mL of specimen.
Conclusion
Our data indicate that persistent HEV infection is an infrequent cause of ALT elevation in Indian renal transplant recipients who are receiving immunosuppressive drugs. This suggests that infection with genotype 1 HEV may have either no or low potential to cause persistent infection.
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Acknowledgments
The authors thank Mr. Vishwajeet Yadav and Ms. Pallavi Shukla for technical help.
Conflict of interest
SM, NG, RKS, AG, NP, AK, DB, AG, and RA all declare that they have no conflict of interest.
Ethics statement
The authors declare that the survey was performed in a manner that conforms to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that the authors followed the policy concerning informed consent wherever applicable as shown in www.Springer.com.
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Munjal, S., Gupta, N., Sharma, R.K. et al. Lack of persistent hepatitis E virus infection as a cause for unexplained transaminase elevation in renal transplant recipients in India. Indian J Gastroenterol 33, 550–553 (2014). https://doi.org/10.1007/s12664-014-0508-5
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DOI: https://doi.org/10.1007/s12664-014-0508-5