Buti et al.1 investigated 108 serum samples from liver and kidney recipients with elevated liver tests, and they found a prevalence of hepatitis E virus (HEV) immunoglobulin G (IgG) of 2.7%, which is not higher than the prevalence in the general population. They concluded that these results contradicted previous reports from areas with low rates of HEV prevalence suggesting that solid organ transplant recipients could be a risk population for HEV infection.
In response, we think that it is important to distinguish between the risk of acquiring the virus, the subsequent risk of developing chronic hepatitis E, and the possible implications of long-term carriers of HEV for the environment. The risk of acquisition of the virus is most likely not different in organ transplant recipients and the general population. This explains the low prevalence in both groups in low endemic areas. We also found a low prevalence of HEV IgG in our liver transplant recipients (ie, 2.1%).2 However, organ transplant recipients carry an increased risk for the development of chronic hepatitis, which may end in cirrhosis. The organ recipients with chronic hepatitis E are long-term carriers of the virus and may serve as a source of HEV virus in the general population. We have shown that patients may carry the virus for many years before seroconversion to HEV RNA negativity and HEV IgG positivity.2, 3 So far, to the best of our knowledge, no studies have been performed to determine if people in the close environment of these patients carry an increased risk for the acquisition of the virus.
In conclusion, solid organ transplant recipients may not be at increased risk for HEV infection in comparison with the general population, but they are at increased risk for chronic hepatitis E once the virus is acquired. The role of chronic carriers as a possible HEV reservoir in the population remains to be established.