engleski

Socio-demographic risk factors for high HEV seroprevalence among liver transplant recipients in Croatia

Background: Hepatitis E virus (HEV) is an emerging disease in Europe, especially important among solidorgan transplant (SOT) recipients who are at greater risk of developing acute and chronic hepatitis with progression to cirrhosis. The foodborne transmission is considered the main route of HEV infection in developed countries. However, risk factors for the HEV acquisition among SOT recipients are still incompletely understood. The aim of this study was to determine the HEV exposure in LT cohort and to identify sociodemographic risk factors related to HEV seropositivity. Methods: 242 Croatian liver transplant (LT) recipients completed a risk factor assessment questionnaire and were screened for anti-HEV IgG during post- transplant outpatient visits. Blood samples were tested for antiHEV IgG using an enzyme immune assay (Mikrogen, Germany), confirmed by Western blot (Mikrogen, Germany). Results: Anti-HEV IgG seroprevalence in LT recipients was 24.38%. The median time after LT was 5 years (range 19 years). The majority of the recipients were male (69.0%) and the major indication for LT was alcoholic liver disease (50.4%). The HEV seroprevalence in our transplant cohort was associated with older age (OR=1.05 ; 95%CI=1.02- 1.09), female gender (OR=2.61 ; 95%CI=1.42-4.81), rural area of residence (AOR=2.17 ; 95%CI=1.10- 4.27), and specific factors within a household, a farm (AOR=2.79 ; 95% CI=1.31-5.92), a water-well (AOR=3.09 ; 95%CI=1.11-8.57) and a sewage system connected to a septic tank (AOR=3.38 ; 95%CI=1.64-6.95). The highest level of education (AOR=0.05 ; 95%CI=0.01- 0.43) and a recent travelling experience (AOR=0.39 ; 95%CI=0.17- 0.88) were linked to a lower HEV seroprevalence. Contrary to initial assumptions, production and/or consummation of cured meat and occupational exposure had no statistically significant strength of association with antiHEV IgG seropositivity. Conclusion: Our results show that anti-HEV IgG seroprevalence is high (24.38%) among LT recipients in South-eastern Europe (Croatia). The identified sociodemographic factors associated with the seropositvity set up a platform for further research directions to evaluate sources/routes of transmission and clinical impact of HEV infection after solid- organ transplantation.

hepatitis E virus ; seroprevalence ; liver transplantation ; risk factors ; socio-demographic risk factors ; Croatia

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