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HEV in Solid Organ Transplant Patients

Pediatric Liver News
February 14, 2013

Paul Sue, MD, Wikrom Karnsakul, MD

Collaborators in the lab, pediatric infectious disease specialist Paul Sue (left) and pediatric hepatologist Wikrom Karnsakul aim to illuminate the role of hepatitis E virus infection in solid organ transplant patients. 

What is the risk of hepatitis E virus (HEV) infection in solid organ transplant recipients? How prevalent is it, and is it more common in certain parts of the country?

Spurred by such questions and what they perceive as a general lack of awareness of HEV in this country, pediatric hepatologist Wikrom Karnsakul and pediatric infectious disease specialist Paul Sue have launched two new collaborative studies involving HEV in solid organ—kidney, liver, pancreas, heart and lung— transplantation. The answers, they say, could improve understanding of HEV infection in such cases, lead to a much needed FDA-approved serological test to detect the presence of the virus, improve HEV detection, and pave the way to new therapies.

“Hepatitis E is more of a problem in developing countries but you can get it even in very hygienic countries,” says Karnsakul. “The knowledge in this field would help us to develop testing and, if there is an infection, allow us to lower the immunosuppression and start antiviral treatment.”

“There’re quite a number of commercial assays with variable degrees of sensitivity and quality, but there has not been a clear standard tested and approved by the FDA,” adds Sue. “Hepatitis E is usually not on the clinician’s mind in this country.”

In one study, working with the Johns Hopkins Immunogenetics Laboratory, Sue and Karnsakul are analyzing five years of banked sera from solid organ transplant patients to determine the prevalence of infection from hepatitis E virus. In the other study, the two investigators will be comparing the prevalence of the infection in patients before and after liver transplantation.

Why transplant recipients? In individuals with normal immune function the infection does not usually lead to significant complications like fulminant hepatitis or the development of chronic infection and cirrhosis. But in immunesuppressed patients, like solid organ transplant recipients, the risks are higher.

“We would like to know who would be at risk of acquiring this infection, which is critical for caring for these solid-organ transplant patients because with this infection they could lose the organ graft,” says Karnsakul. “The bottom line is that we could develop a management plan to treat this infection.”

Building on the work of other investigators, Sue and Karnsakul are also hoping to illuminate environmental factors that may play a role in HEV infection. For example, previous studies have shown that HEV is more common among people who consume uncooked game meat. 

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