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Course and treatment of chronic hepatitis E virus infection in lung transplant recipients.
Transpl Infect Dis. 2014 Apr; 16(2):333-9.TI

Abstract

OBJECTIVE

Persistent hepatitis E virus (HEV) infections have been described in various transplant cohorts. However, the frequency and the course of HEV infection in lung transplant recipients (Lu-Tr) are not well defined.

METHODS

We retrospectively analyzed serum from 95 Lu-Tr for HEV RNA and anti-HEV immunoglobulin-G (IgG) (with the MP assay). Anti-HEV seroprevalence was compared to that of 537 healthy individuals. Prospective HEV screening was subsequently initiated in Lu-Tr.

RESULTS

Elevated liver enzymes were observed in 44/95 (46.3%) patients. Anti-HEV IgG was present in 5/95 patients (5.3%), revealing a slightly higher prevalence compared to controls (2%, 11/537; P = 0.07). Chronic HEV infection with detectable viral replication was confirmed by polymerase chain reaction in 3 (3.2%) patients, all of whom demonstrated clinical and biochemical features of active liver disease (maximum alanine aminotransferase [ALTmax ] 89, 215, and 270 IU/L, respectively). One patient had died from multi-organ failure in combination with liver cirrhosis before HEV diagnosis. Two additional patients with chronic hepatitis E were identified during prospective screening (ALTmax 359 and 318 IU/L). All patients still alive commenced ribavirin therapy for 5 months, with dose adjustment (400-600 mg/day) according to renal function and hemoglobin level. Sustained resolution of HEV infection occurred in 2 patients. One patient is still under treatment, and the fourth died from graft failure considered unrelated to ribavirin therapy.

CONCLUSION

Chronic hepatitis E should be considered in the differential diagnosis of elevated liver enzymes, which are commonly seen in Lu-Tr. We observed 1 case of end-stage liver cirrhosis and death in an HEV-infected subject, who was not treated with ribavirin. Given this potentially devastating consequence, ribavirin therapy of persistent HEV infection appears to be acceptably safe and effective in Lu-Tr. However, larger prospective studies are warranted.

Authors+Show Affiliations

Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; IFB-TX, Hannover, Germany.No 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24438577

Citation

Pischke, S, et al. "Course and Treatment of Chronic Hepatitis E Virus Infection in Lung Transplant Recipients." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 16, no. 2, 2014, pp. 333-9.
Pischke S, Greer M, Hardtke S, et al. Course and treatment of chronic hepatitis E virus infection in lung transplant recipients. Transpl Infect Dis. 2014;16(2):333-9.
Pischke, S., Greer, M., Hardtke, S., Bremer, B., Gisa, A., Lehmann, P., Haverich, A., Welte, T., Manns, M. P., Wedemeyer, H., & Gottlieb, J. (2014). Course and treatment of chronic hepatitis E virus infection in lung transplant recipients. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 16(2), 333-9. https://doi.org/10.1111/tid.12183
Pischke S, et al. Course and Treatment of Chronic Hepatitis E Virus Infection in Lung Transplant Recipients. Transpl Infect Dis. 2014;16(2):333-9. PubMed PMID: 24438577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Course and treatment of chronic hepatitis E virus infection in lung transplant recipients. AU - Pischke,S, AU - Greer,M, AU - Hardtke,S, AU - Bremer,B, AU - Gisa,A, AU - Lehmann,P, AU - Haverich,A, AU - Welte,T, AU - Manns,M P, AU - Wedemeyer,H, AU - Gottlieb,J, AU - ,, Y1 - 2014/01/20/ PY - 2013/05/06/received PY - 2013/07/05/revised PY - 2013/08/03/accepted PY - 2014/1/21/entrez PY - 2014/1/21/pubmed PY - 2015/1/22/medline KW - chronic infection KW - hepatitis E KW - lung transplantation SP - 333 EP - 9 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 16 IS - 2 N2 - OBJECTIVE: Persistent hepatitis E virus (HEV) infections have been described in various transplant cohorts. However, the frequency and the course of HEV infection in lung transplant recipients (Lu-Tr) are not well defined. METHODS: We retrospectively analyzed serum from 95 Lu-Tr for HEV RNA and anti-HEV immunoglobulin-G (IgG) (with the MP assay). Anti-HEV seroprevalence was compared to that of 537 healthy individuals. Prospective HEV screening was subsequently initiated in Lu-Tr. RESULTS: Elevated liver enzymes were observed in 44/95 (46.3%) patients. Anti-HEV IgG was present in 5/95 patients (5.3%), revealing a slightly higher prevalence compared to controls (2%, 11/537; P = 0.07). Chronic HEV infection with detectable viral replication was confirmed by polymerase chain reaction in 3 (3.2%) patients, all of whom demonstrated clinical and biochemical features of active liver disease (maximum alanine aminotransferase [ALTmax ] 89, 215, and 270 IU/L, respectively). One patient had died from multi-organ failure in combination with liver cirrhosis before HEV diagnosis. Two additional patients with chronic hepatitis E were identified during prospective screening (ALTmax 359 and 318 IU/L). All patients still alive commenced ribavirin therapy for 5 months, with dose adjustment (400-600 mg/day) according to renal function and hemoglobin level. Sustained resolution of HEV infection occurred in 2 patients. One patient is still under treatment, and the fourth died from graft failure considered unrelated to ribavirin therapy. CONCLUSION: Chronic hepatitis E should be considered in the differential diagnosis of elevated liver enzymes, which are commonly seen in Lu-Tr. We observed 1 case of end-stage liver cirrhosis and death in an HEV-infected subject, who was not treated with ribavirin. Given this potentially devastating consequence, ribavirin therapy of persistent HEV infection appears to be acceptably safe and effective in Lu-Tr. However, larger prospective studies are warranted. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/24438577/Course_and_treatment_of_chronic_hepatitis_E_virus_infection_in_lung_transplant_recipients_ L2 - https://doi.org/10.1111/tid.12183 DB - PRIME DP - Unbound Medicine ER -