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Transplantation. 2018 Aug;102(8):1351-1357. doi: 10.1097/TP.0000000000002185.

Transmission of Hepatitis E Virus With Plasma Exchange in Kidney Transplant Recipients: A Retrospective Cohort Study.

Author information

1
Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
2
Institut Pasteur, Institut National de la Santé et de la Recherche Médicale (Inserm), Paris, France.
3
Hepatology Service, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port-Royal, Paris, France.
4
Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Nephrology and Kidney Transplantation Service, Paris, France.
5
Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Paul Brousse, Virology Service, Villejuif, France.
6
Institut National de la Santé et de la Recherche Médicale (Inserm), Villejuif, France.
7
Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Cochin Port Royal, Hematology Service, Paris, France.
8
Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Virology Service, Paris France.
9
Etablissement Français du Sang Île-de-France, Unité de Gestion des Risques et de la Qualité, Centre Hospitalier Universitaire Européen Georges Pompidou, Paris, France.
10
Etablissement Français du Sang Île-de-France, Site Transfusionnel Pitié-Salpêtrière, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
11
INSERM UMR 1043-CNRS UMR 5282, Toulouse, France.
12
Department of Virology, CNR HEV, CHU Toulouse, France.
13
Université Paul Sabatier, Toulouse, France.

Abstract

BACKGROUND:

After observing a case of plasma exchange-mediated hepatitis E virus (HEV) infection 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 ribonucleic acid (RNA), on 3 consecutive blood samples: 1 before, 1 with a mean (standard deviation) of 9.5 (9) months, and 1 with a mean (standard deviation) 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.

CONCLUSIONS:

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.

PMID:
29561324
DOI:
10.1097/TP.0000000000002185
[Indexed for MEDLINE]

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