Author’s Reply: Hepatitis E Virus Infection in Iranian Kidney-Transplant Patients

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Article Information:

Group: 2011
Subgroup: Volume 11, Issue 11, Nov
Date: November 2011
Type: Letter to Editor
Start Page: 929
End Page: 930
PMID: 22308160
PMCID: PMC3269064
DOI: 10.5812/kowsar.1735143X.790


  • Zakieh Rostamzadeh Khameneh
  • Department of Microbiology, Urmia University of Medical Sciences, Urmia, IR Iran
  • Nariman Sepehrvand
  • National Institute of Health Research, Tehran University of Medical Sciences, Tehran, IR Iran


      Affiliation: National Institute of Health Research, Tehran University of Medical Sciences
      City, Province: Tehran,
      Country: IR Iran
      Tel: +98-9125936372
      Fax: +98- 4412231930

Manuscript Body:

Please cite this paper as:
Rostamzadeh Khameneh Z, Sepehrvand N. Author’s Reply: Hepatitis E Virus Infection in Iranian Kidney-Transplant Patients.
Hepat Mon. 2011;11(11):929-30. DOI: 10.5812/kowsar.1735143X.790


Dear Editor,
On behalf of all of the coauthors, I would like to thank Dr. Kamar for his interest in our study. In the letter, Dr. Kamar summarized the most important findings on hepatitis E infection in organ transplant recipients (1), most of whom have relied on the valuable contributions by of Dr. Kamar's group in France (2-4). In our study, we noted a high seroprevalence of anti-HEV IgG. Almost 30% of transplant recipients were seropositive for anti-HEV IgG (5). We also found unexplained increases in liver function tests in transplant recipients. However, there was no significant difference in serum alanine transferase (ALT) levels between anti-HEV-seropositive and -seronegative groups (5).
As mentioned in the letter, serological methods have certain limitations. There are doubts regarding the diagnostic value of anti-HEV IgG serological evaluation in the diagnosis of HEV infection. In a study in Taiwan, an area in which hepatitis E is not endemic, the sensitivity of anti-HEV IgG compared with reverse-transcription PCR was 86.7% (6). Its specificity in diagnosing acute hepatitis was 92%. Lin et al. concluded that anti-HEV IgG is a good test for screening acute hepatitis E in nonendemic areas (6). Jiang et al. evaluated the quality of diagnostic ELISA kits in detecting HEV-specific IgG using HEV diagnostic reference sera from positive and negative cases, observing that the conformity of positive results exceeded 90% in all kits (7). In contrast, Zaki et al., in Egypt, an endemic area for hepatitis E, found the sensitivity of anti-HEV IgG to be very low (2.3%) (8). It appears that the diagnostic value of anti-HEV IgG serological tests in endemic areas is questionable.
As emphasized by Dr. Kamar, the setting of transplant recipients in Iran requires further evaluation using more specific modalities, such as polymerase chain reaction (PCR). Studying the presence of HEV RNA, its relationship with elevated liver enzymes, and acute or chronic forms of infection in these patients is recommended.


References: (8)

  1. Kamar N. Hepatitis E Virus Infection in Iranian Kidney-Transplant Patients. Hepat Mon. 2011;11(11):927-8. [Hepat Mon][DOI: 10.5812/kowsar.1735143X.791 ]
  2. Kamar N, Mansuy JM, Cointault O, Selves J, Abravanel F, Danjoux M, et al. Hepatitis E virus-related cirrhosis in kidney- and kidney-pancreas-transplant recipients. Am J Transplant. 2008;8(8):1744 - 8. [PubMed][DOI: 10.1111/j.1600-6143.2008.02286.x ]
  3. Kamar N, Rostaing L, Selves J, Sandres-Saune K, Alric L, Durand D, et al. Natural history of hepatitis C virus-related liver fibrosis after renal transplantation. Am J Transplant. 2005;5(7):1704 - 12. [PubMed][DOI: 10.1111/j.1600-6143.2005.00918.x ]
  4. Kamar N, Selves J, Mansuy JM, Ouezzani L, Peron JM, Guitard J, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. New Engl J Med. 2008;358(8):811-7. [PubMed][DOI: 10.1056/NEJMoa0706992 ]
  5. Khameneh ZR, Sepehrvand N, Masudi S. Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients. Hepat Mon. 2011;11(8):646-51. [Hepat Mon][DOI: 10.5812/kowsar.1735143X.690 ]
  6. Lin CC, Wu JC, Chang TT, Chang WY, Yu ML, Tam AW, et al. Diagnostic value of immunoglobulin G (IgG) and IgM anti-hepatitis E virus (HEV) tests based on HEV RNA in an area where hepatitis E is not endemic. J Clin Microbiol. 2000;38(11):3915 - 8. [PubMed][DOI: ]
  7. Jiang YZ, Tian RG, Lu J, Bi SL. [Evaluation of the ELISA diagnostic kits for hepatitis E virus antibody in the reference serum, the suspect patients of hepatitis E and normal persons' sera]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2007;21(1):59 - 61. [PubMed][DOI: ]
  8. Zaki M-S, Foud MF, Mohamed AF. Value of hepatitis E virus detection by cell culture compared with nested PCR and serological studies by IgM and IgG. FEMS Immunol Med Microbiol. 2009;56(1):73 - 9. [PubMed][DOI: 10.1111/j.1574-695X.2009.00552.x]