Transmission of hepatitis E virus with plasma exchange in kidney-transplant recipients: a retrospective cohort study

Background: After observing a case of plasma exchange-mediated HEV infections in a kidney transplant recipient, we investigated the relationship between plasma exchange and HEV infection after kidney transplantation. Methods: A cohort of 263 patients who underwent kidney transplantation from January 1, 2011 through December 31, 2012 was screened for HEV markers, including anti-HEV IgG and IgM antibodies and HEV RNA, on 3 consecutive blood samples: 1 before, 1 a mean (SD) of 9.5 (9) months and 1 a mean (SD) of 18.2 (6.6) months after transplantation, respectively. Transfusional investigation was performed in patients with detectable HEV RNA. We explored the relationships between plasma exchange, posttransplantation transaminase elevation and HEV markers acquisition. Results: Overall, 24 (9.1%) patients had acquired HEV markers on the first posttransplantation sample, including 2 patients with detectable HEV RNA, and 7 (2.3%) patients had long-term persistent HEV markers on the second posttransplantation sample, including 3 patients with detectable HEV RNA without detectable anti-HEV antibodies. Plasma exchange was an independent risk factor for the acquisition of posttransplantation and long-term persistent HEV markers. Pathogen-reduced plasma-borne transmission of HEV was demonstrated. Plasma exchange and long-term persistent HEV markers were risk factors of posttransplantation transaminase elevation. Conclusion: Plasma exchange, including with pathogen-reduced plasma, is a risk factor for posttransplantation HEV infection and transaminase elevation. Screening for HEV RNA should be carried out in kidney transplant recipients treated with plasma exchange. Corresponding author: Vincent Mallet, MD, PhD, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France; e-mail, vincent.mallet@aphp.fr Role of the funding source The Agence Nationale de la Recherche (ANR) paid for the serological tests. Vincent Mallet is funded by la fondation ARC pour la Recherche sur le Cancer. The Renal Transplant Unit at Necker Hospital belongs to the Fondation Centaure and the Transplantex group, which supports the French network for transplantation research. Conflicts of interest: none Authors Contributions: Conception and design: V. Mallet Analysis and interpretation of the data: V. Mallet, R. Sberro-Soussan, AM Roque-Afonso, L Hauser Drafting of the article: V. Mallet, AM Roque-Afonso, S Pol Critical revision of the article for important intellectual content: V. Mallet, R Sberro-Soussan, AM Roque-Afonso, S Pol Provision of study materials or patients: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol. Final approval of the article: V Mallet, R Sberro-Soussan, AM Roque-Afonso, A Vallet-Pichard, B Deau, A Portal, ML Chaix, L Hauser, A Beylouné, A Mercadier, J Izopet, C Legendre, S Pol Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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