BACKGROUND Southeast Asia is the endemic area of hepatitis E virus (HEV) infection. We aimed to determine the seroprevalence of the virus, its association, and the prevalence of chronic infection after pediatric liver transplantation (LT). METHODS A cross-sectional study was performed in Bangkok, Thailand. Patients aged <18 years who had LT for >2 years underwent serologic and real-time polymerase chain reaction (rt-PCR) tests. Acute HEV infection was defined by the presence of positive anti-HEV immunoglobulin (Ig)M and HEV viremia from the rt-PCR. If the viremia persisted for >6 months, chronic HEV infection was diagnosed. RESULTS A total of 101 patients had a median age of 8.4 years [interqartile range (IQR): 5.8-11.7]. The seroprevalence of anti-HEV IgG and IgM was 15% and 4%, respectively. Positive IgM and/or IgG were associated with a history of elevated transaminases with an unknown cause after LT (p = 0.04 and p = 0.01, respectively). The presence of HEV IgM was associated with a history of elevated transaminases with an unknown cause within 6 months (p = 0.01). The two patients (2%) diagnosed with chronic HEV infection did not fully respond to the reduction of immunosuppression but responded well to ribavirin treatment. CONCLUSIONS Seroprevalence of HEV among pediatric LT recipients was not rare in Southeast Asia. Since HEV seropositivity was associated with elevated transaminases of an unknown cause, investigation for the virus should be offered in LT children with hepatitis after excluding other etiologies. Pediatric LT recipients with chronic HEV infection may receive a benefit from a specific antiviral treatment.

中文翻译：

---

小儿肝移植后戊型肝炎病毒的血清阳性率。

背景技术东南亚是戊型肝炎病毒（HEV）感染的流行区。我们的目的是确定病毒的血清阳性率、其相关性以及小儿肝移植 (LT) 后慢性感染的流行率。方法 在泰国曼谷进行了一项横断面研究。年龄 <18 岁且 LT 超过 2 年的患者接受了血清学和实时聚合酶链反应 (rt-PCR) 检测。急性 HEV 感染的定义是存在 rt-PCR 阳性抗 HEV 免疫球蛋白 (Ig)M 和 HEV 病毒血症。如果病毒血症持续超过 6 个月，则诊断为慢性 HEV 感染。结果 共有 101 名患者的中位年龄为 8.4 岁 [四分位间距 (IQR)：5.8-11.7]。抗 HEV IgG 和 IgM 的血清阳性率分别为 15% 和 4%。阳性 IgM 和/或 IgG 与 LT 后不明原因的转氨酶升高史相关（分别为 p = 0.04 和 p = 0.01）。HEV IgM 的存在与 6 个月内不明原因的转氨酶升高史有关 (p = 0.01)。两名被诊断患有慢性 HEV 感染的患者 (2%) 对免疫抑制的减少没有完全反应，但对利巴韦林治疗反应良好。结论 儿科 LT 接受者的 HEV 血清阳性率在东南亚并不罕见。由于 HEV 血清阳性与不明原因的转氨酶升高有关，因此应在排除其他病因后对患有肝炎的 LT 儿童进行病毒检查。患有慢性 HEV 感染的儿童 LT 接受者可能会从特定的抗病毒治疗中获益。