Towards Systematic Screening for Persistent Hepatitis E Virus (HEV) Infections in Transplant Patients.

Background: Persistent hepatitis E virus genotype 3 (HEV G3) infections affect solid organ transplant (SOT) recipients and haematopoietic stem cell transplant (HSCT) recipients, but the burden in these cohorts in the UK is unknown. We established an audit to determine the point prevalence of HEV viraemia in SOT and HSCT patients in the UK and compare different testing approaches to inform screening strategies. Methods: Between 5th January and 21st September 2016, 3044 patients undergoing therapeutic drug monitoring at a single transplant centre were screened for HEV RNA in minipools. A total of 2822 patients who could be characterised included 2419 SOT patients, 144 HSCT patients and 259 patients with no available transplant history. HEV RNA-positive samples were characterised by serology and genomic phylogeny. HEV antigen (HEV-Ag) testing was performed on RNA-positive samples, 420 RNA-negative samples and 176 RNA-negative blood donor samples. Results: Nineteen of 2822 patients were viraemic with G3 HEV giving a prevalence of 0.67%. The median alanine aminotransferase (ALT) was significantly higher in the HEV viraemic patients (p

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