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Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation.
Transplantation. 2010 Feb 15; 89(3):353-60.T

Abstract

BACKGROUND

Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-organ transplant patients.

METHODS

We identified 33 cases of autochthonous acute HEV infection in solid-organ transplant patients.

RESULTS

Among 27 HEV-positive patients, who had a follow-up of more than 6 months, 16 (59.25%) evolved to chronic HEV infection, defined by persisting elevated liver-enzyme levels and positive serum HEV RNA 6 months after diagnosis. Serial liver biopsies showed progression in liver activity and liver fibrosis. Three patients developed liver cirrhosis. The proportion of patients receiving tacrolimus compared with cyclosporine A was significantly higher in patients who evolved to chronic disease. Immunosuppressive therapy was reduced in patients with chronic hepatitis; however, those who had a dramatic decrease in tacrolimus trough levels were more likely to clear the virus. Four chronic liver transplant patients were cleared off the virus at 14, 16, 22, and 23 months after diagnosis. At last follow-up, their tacrolimus trough levels and daily steroid doses were significantly lower than those who remained viremic. These four patients had lower liver-enzyme levels and lower activity scores on liver biopsies, and their peripheral blood CD3- and CD4-positive cell counts were also significantly higher.

CONCLUSIONS

The rate of chronic HEV-related hepatitis is approximately 60% in solid-organ transplant patients. When possible, the reduction of immunosuppressive drugs targeting T cells should be considered as a first-line therapeutic option.

Authors+Show Affiliations

Department of Nephrology, Dialysis and Multi-Organ Transplantation, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20145528

Citation

Kamar, Nassim, et al. "Influence of Immunosuppressive Therapy On the Natural History of Genotype 3 hepatitis-E Virus Infection After Organ Transplantation." Transplantation, vol. 89, no. 3, 2010, pp. 353-60.
Kamar N, Abravanel F, Selves J, et al. Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation. Transplantation. 2010;89(3):353-60.
Kamar, N., Abravanel, F., Selves, J., Garrouste, C., Esposito, L., Lavayssière, L., Cointault, O., Ribes, D., Cardeau, I., Nogier, M. B., Mansuy, J. M., Muscari, F., Peron, J. M., Izopet, J., & Rostaing, L. (2010). Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation. Transplantation, 89(3), 353-60. https://doi.org/10.1097/TP.0b013e3181c4096c
Kamar N, et al. Influence of Immunosuppressive Therapy On the Natural History of Genotype 3 hepatitis-E Virus Infection After Organ Transplantation. Transplantation. 2010 Feb 15;89(3):353-60. PubMed PMID: 20145528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation. AU - Kamar,Nassim, AU - Abravanel,Florence, AU - Selves,Janick, AU - Garrouste,Cyril, AU - Esposito,Laure, AU - Lavayssière,Laurence, AU - Cointault,Olivier, AU - Ribes,David, AU - Cardeau,Isabelle, AU - Nogier,Marie Béatrice, AU - Mansuy,Jean Michel, AU - Muscari,Fabrice, AU - Peron,Jean Marie, AU - Izopet,Jacques, AU - Rostaing,Lionel, PY - 2010/2/11/entrez PY - 2010/2/11/pubmed PY - 2010/3/24/medline SP - 353 EP - 60 JF - Transplantation JO - Transplantation VL - 89 IS - 3 N2 - BACKGROUND: Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-organ transplant patients. METHODS: We identified 33 cases of autochthonous acute HEV infection in solid-organ transplant patients. RESULTS: Among 27 HEV-positive patients, who had a follow-up of more than 6 months, 16 (59.25%) evolved to chronic HEV infection, defined by persisting elevated liver-enzyme levels and positive serum HEV RNA 6 months after diagnosis. Serial liver biopsies showed progression in liver activity and liver fibrosis. Three patients developed liver cirrhosis. The proportion of patients receiving tacrolimus compared with cyclosporine A was significantly higher in patients who evolved to chronic disease. Immunosuppressive therapy was reduced in patients with chronic hepatitis; however, those who had a dramatic decrease in tacrolimus trough levels were more likely to clear the virus. Four chronic liver transplant patients were cleared off the virus at 14, 16, 22, and 23 months after diagnosis. At last follow-up, their tacrolimus trough levels and daily steroid doses were significantly lower than those who remained viremic. These four patients had lower liver-enzyme levels and lower activity scores on liver biopsies, and their peripheral blood CD3- and CD4-positive cell counts were also significantly higher. CONCLUSIONS: The rate of chronic HEV-related hepatitis is approximately 60% in solid-organ transplant patients. When possible, the reduction of immunosuppressive drugs targeting T cells should be considered as a first-line therapeutic option. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/20145528/Influence_of_immunosuppressive_therapy_on_the_natural_history_of_genotype_3_hepatitis_E_virus_infection_after_organ_transplantation_ L2 - https://doi.org/10.1097/TP.0b013e3181c4096c DB - PRIME DP - Unbound Medicine ER -