Epidemiologia e história natural da infecção pelo vírus da hepatite E no transplante hepático
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Data
2023-12-21
Autores
Zicker, Michelle [UNIFESP]
Orientadores
Camargo, Luís Fernando Aranha [UNIFESP]
Tipo
Tese de doutorado
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Objetivos: determinar a prevalência da infecção pelo vírus da hepatite E em uma população de receptores de transplante hepático realizados no Brasil e identificar as frequências dos genótipos virais encontrados nessas infecções; determinar os genótipos do vírus da hepatite E causadores de hepatite aguda e descrever a história natural da infecção pelo vírus da hepatite E na população alvo. Métodos: estudo prospectivo com a realização sistemática e periódica de sorologia, reação em cadeia da polimerase e genotipagem séricos para hepatite E em pacientes maiores de 18 anos, submetidos a transplante hepático no Hospital Israelita Albert Einstein entre 2019 e 2020 e acompanhados durante um ano após o procedimento. Resultados: foram incluídos 107 receptores de transplante hepático, 83 doadores falecidos e analisadas 765 amostras de sangue. A maioria dos participantes era do sexo masculino (73%), com média de idade de 53,5 anos. Cirrose hepática alcóolica foi a doença hepática de base mais frequente. Cerca de 72% dos pacientes eram naturais da região Sudeste do país e 94% proveniente da mesma região. Encontrou-se prevalência de hepatite E de 10.2% nos receptores e de 9.7% nos doadores. Não foi observada diferença estatisticamente significativa entre as variáveis clínicas dos receptores que apresentaram imunoglobulina G anti-hepatite E positiva e negativa no pré-transplante inclusive em relação aos fatores de risco para infecção pelo vírus da hepatite E, desfecho clínico após um ano de seguimento e necessidade de retransplante. Nenhum paciente apresentou carga viral detectável no pré-transplante ou durante as coletas de seguimento. Não foram identificados episódios de infecção aguda, de reativação ou soroconversão, mesmo nas situações de discordância sorológica entre receptor e doador. Não se identificou transmissão do vírus da hepatite E através do enxerto não sendo possível determinar o genótipo e a incidência da infecção aguda. Conclusões: Infecção aguda e crônica pelo vírus da hepatite E parecem ser eventos raros na população estudada, possivelmente em decorrência de fatores sociais, econômicos e ambientais. Os dados encontrados sugerem que entre receptores de transplante hepático no Brasil a infecção pelo vírus da hepatite E deve ser investigada somente no cenário de aumento de transaminases ou enzimas canaliculares sem causa definida, como parte do diagnóstico diferencial das hepatites soronegativas após o transplante. Considerando as dimensões e heterogeneidade dos hábitos e condições socioeconômicas da população brasileira, outros estudos envolvendo receptores de transplante hepático deveriam ser conduzidos nas demais regiões do país.
Objectives: to determine the prevalence of hepatitis E virus infection in a group of liver transplant recipients performed in Brazil and to identify the frequencies of viral genotypes found in these infections; to determine the hepatitis E virus genotypes causing acute hepatitis and to describe the natural history of hepatitis E virus infection in the target population. Methods: this is a prospective study with systematic and periodic analysis of serology, polymerase chain reaction and serum genotyping for hepatitis E in patients over 18 years of age who underwent liver transplantation at Hospital Israelita Albert Einstein between 2019 and 2020 and were followed up for one year after the procedure. Results: 107 liver transplant recipients, 83 deceased donors were included and 765 blood samples were analyzed. Most participants were male (73%), with a mean age of 53.5 years. Alcoholic liver cirrhosis was the most frequent underlying liver disease. About 72% of the patients were born in the Southeast region of the country and 94% lived in the same region. Prevalence of hepatitis E infection was 10.2% in recipients and 9.7% in donors. No statistically significant difference was observed between the clinical variables of recipients who had positive and negative anti hepatitis E immunoglobulin G pre-transplantation, even regarding the risk factors for hepatitis E virus infection, clinical outcomes after one year of follow-up and need for retransplant. No patient had hepatitis E virus detected through polymerase chain reaction pre-transplantation or during follow-up analysis. No episodes of acute infection, reactivation or seroconversion were identified, even in situations of serological disagreement between recipient and donor. Transmission of the hepatitis E virus through the graft was not identified, and it was not possible to determine the genotype and incidence of acute infection. Conclusions: Acute and chronic infection caused by hepatitis E virus seems to be rare events in the studied population, possibly due to social, economic and environmental factors. These data suggest that among liver transplant recipients in Brazil, hepatitis E virus infection should be investigated only in the context of increased transaminases or canalicular enzymes without a defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation. Considering the dimensions and heterogeneity of habits and socioeconomic conditions of the Brazilian population, other studies involving liver transplant recipients should be conducted in other regions of the country.
Objectives: to determine the prevalence of hepatitis E virus infection in a group of liver transplant recipients performed in Brazil and to identify the frequencies of viral genotypes found in these infections; to determine the hepatitis E virus genotypes causing acute hepatitis and to describe the natural history of hepatitis E virus infection in the target population. Methods: this is a prospective study with systematic and periodic analysis of serology, polymerase chain reaction and serum genotyping for hepatitis E in patients over 18 years of age who underwent liver transplantation at Hospital Israelita Albert Einstein between 2019 and 2020 and were followed up for one year after the procedure. Results: 107 liver transplant recipients, 83 deceased donors were included and 765 blood samples were analyzed. Most participants were male (73%), with a mean age of 53.5 years. Alcoholic liver cirrhosis was the most frequent underlying liver disease. About 72% of the patients were born in the Southeast region of the country and 94% lived in the same region. Prevalence of hepatitis E infection was 10.2% in recipients and 9.7% in donors. No statistically significant difference was observed between the clinical variables of recipients who had positive and negative anti hepatitis E immunoglobulin G pre-transplantation, even regarding the risk factors for hepatitis E virus infection, clinical outcomes after one year of follow-up and need for retransplant. No patient had hepatitis E virus detected through polymerase chain reaction pre-transplantation or during follow-up analysis. No episodes of acute infection, reactivation or seroconversion were identified, even in situations of serological disagreement between recipient and donor. Transmission of the hepatitis E virus through the graft was not identified, and it was not possible to determine the genotype and incidence of acute infection. Conclusions: Acute and chronic infection caused by hepatitis E virus seems to be rare events in the studied population, possibly due to social, economic and environmental factors. These data suggest that among liver transplant recipients in Brazil, hepatitis E virus infection should be investigated only in the context of increased transaminases or canalicular enzymes without a defined cause, as part of the differential diagnosis of seronegative hepatitis after transplantation. Considering the dimensions and heterogeneity of habits and socioeconomic conditions of the Brazilian population, other studies involving liver transplant recipients should be conducted in other regions of the country.
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Citação
ZICKER, Michelle. Epidemiologia e história natural da infecção pelo vírus da hepatite E no transplante hepático. 2023. 93 f. Tese (Doutorado em Infectologia) - Esola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.