Hepatitis E virus screening in solid organ transplant recipients: prevalence and implications for implementation, Spain, 2021 to 2023

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.