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Chronic hepatitis E virus infection in liver transplant recipients.
Liver Transpl. 2008 Apr; 14(4):547-53.LT

Abstract

Hepatitis E virus (HEV) infection is known to run a self-limiting course. Sporadic cases of acute hepatitis due to infection with HEV genotype 3, present in pig populations, are increasingly recognized. Zoonotic transmission seems infrequent. The entity of unexplained chronic hepatitis after liver transplantation has been recognized. Detection of HEV in 2 liver transplant recipients triggered a review of these cases. Freeze-stored sera were available for retrospective analysis. HEV antibodies were determined. For virus detection and identification, a fragment of the gene encoding the major capsid protein (open reading frame 2) was amplified by reverse-transcription polymerase chain reaction and sequenced to identify the genotype. Two months after liver transplantation, case A developed unexplained chronic hepatitis, which developed into cirrhosis. Retransplantation followed 7 years later, after which chronic hepatitis recurred. In retrospect, HEV RNA was present in serum 3 weeks after the first transplantation and remained present afterwards. HEV RNA was also present in retransplant liver tissue. HEV antibodies appeared late after retransplantation. Case B developed unexplained chronic hepatitis 7 years after transplantation. Retransplantation was needed 5 years later, after which no signs of hepatitis recurred. In retrospect, the period of chronic hepatitis up to the retransplantation coincided with HEV RNA in serum. In case B, antibodies developed, the viral load was much lower than in case A, and the virus seemed to be cleared after retransplantation. Genotyping in both cases revealed 2 unique strains of genotype 3. In conclusion, chronic HEV infection may develop in immunosuppressed patients, who may then serve as long-term carriers of the virus. We hypothesize that HEV may be the cause of chronic hepatitis in liver transplant recipients.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, The Netherlands. e.b.haagsma@int.umcg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18383084

Citation

Haagsma, Elizabeth B., et al. "Chronic Hepatitis E Virus Infection in Liver Transplant Recipients." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 14, no. 4, 2008, pp. 547-53.
Haagsma EB, van den Berg AP, Porte RJ, et al. Chronic hepatitis E virus infection in liver transplant recipients. Liver Transpl. 2008;14(4):547-53.
Haagsma, E. B., van den Berg, A. P., Porte, R. J., Benne, C. A., Vennema, H., Reimerink, J. H., & Koopmans, M. P. (2008). Chronic hepatitis E virus infection in liver transplant recipients. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 14(4), 547-53. https://doi.org/10.1002/lt.21480
Haagsma EB, et al. Chronic Hepatitis E Virus Infection in Liver Transplant Recipients. Liver Transpl. 2008;14(4):547-53. PubMed PMID: 18383084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic hepatitis E virus infection in liver transplant recipients. AU - Haagsma,Elizabeth B, AU - van den Berg,Arie P, AU - Porte,Robert J, AU - Benne,Cornelis A, AU - Vennema,Harry, AU - Reimerink,Johan H J, AU - Koopmans,Marion P G, PY - 2008/4/3/pubmed PY - 2008/8/7/medline PY - 2008/4/3/entrez SP - 547 EP - 53 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 14 IS - 4 N2 - Hepatitis E virus (HEV) infection is known to run a self-limiting course. Sporadic cases of acute hepatitis due to infection with HEV genotype 3, present in pig populations, are increasingly recognized. Zoonotic transmission seems infrequent. The entity of unexplained chronic hepatitis after liver transplantation has been recognized. Detection of HEV in 2 liver transplant recipients triggered a review of these cases. Freeze-stored sera were available for retrospective analysis. HEV antibodies were determined. For virus detection and identification, a fragment of the gene encoding the major capsid protein (open reading frame 2) was amplified by reverse-transcription polymerase chain reaction and sequenced to identify the genotype. Two months after liver transplantation, case A developed unexplained chronic hepatitis, which developed into cirrhosis. Retransplantation followed 7 years later, after which chronic hepatitis recurred. In retrospect, HEV RNA was present in serum 3 weeks after the first transplantation and remained present afterwards. HEV RNA was also present in retransplant liver tissue. HEV antibodies appeared late after retransplantation. Case B developed unexplained chronic hepatitis 7 years after transplantation. Retransplantation was needed 5 years later, after which no signs of hepatitis recurred. In retrospect, the period of chronic hepatitis up to the retransplantation coincided with HEV RNA in serum. In case B, antibodies developed, the viral load was much lower than in case A, and the virus seemed to be cleared after retransplantation. Genotyping in both cases revealed 2 unique strains of genotype 3. In conclusion, chronic HEV infection may develop in immunosuppressed patients, who may then serve as long-term carriers of the virus. We hypothesize that HEV may be the cause of chronic hepatitis in liver transplant recipients. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/18383084/Chronic_hepatitis_E_virus_infection_in_liver_transplant_recipients_ L2 - https://doi.org/10.1002/lt.21480 DB - PRIME DP - Unbound Medicine ER -