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Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy.
Exp Clin Transplant. 2015 Jun; 13(3):283-6.EC

Abstract

OBJECTIVES

Hepatitis E virus infection is increasingly reported as a cause of chronic hepatitis in organ transplant recipients. Besides reduction of immunosuppressive therapy or pegylated-interferon therapy, promising results have been reported for ribavirin monotherapy of hepatitis E virus after kidney transplant. To our knowledge, this is the first report of a successful ribavirin monotherapy for chronic hepatitis E virus infection after and orthotopic liver transplant.

MATERIALS AND METHODS

This is a case report of a 55-year-old man with a diagnosis of chronic hepatitis E (genotype 3f) 26 months after an orthotopic liver transplant. A reduction of immunosuppressive therapy was not tolerated, and the patient did not qualify for pegylated-interferon therapy. Because of progressively elevated liver transaminases accompanied by histologic changes in the liver allograft, ribavirin monotherapy was undertaken for 16 weeks.

RESULTS

We saw a decrease in liver enzymes after 1 week of ribavirin monotherapy. Hepatitis E virus RNA anti-HEV-IgM were tested after 8 weeks of ribavirin therapy, and were both negative. Antiviral therapy was continued for 16 weeks, and hepatitis E virus RNA remained undetectable; there also was a significant decrease in liver transaminases levels to normal values. In the 8-week and 8-month follow-ups at the end of antiviral therapy, the patient presented with normal liver enzymes and no detectable hepatitis E virus RNA.

CONCLUSIONS

In conclusion, successful therapy of chronic hepatitis E after an orthotopic liver transplant may be achieved by ribavirin monotherapy and should be considered in patients who are sensitive to a reduction of immunosuppressive therapy or pegylated-interferon therapy.

Authors+Show Affiliations

From the Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Institute of Medical Virology, Helmut-Ruska-Haus, Berlin, Germany.No 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

24779678

Citation

Klein, Fritz, et al. "Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy." Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation, vol. 13, no. 3, 2015, pp. 283-6.
Klein F, Neuhaus R, Hofmann J, et al. Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy. Exp Clin Transplant. 2015;13(3):283-6.
Klein, F., Neuhaus, R., Hofmann, J., Rudolph, B., Neuhaus, P., & Bahra, M. (2015). Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy. Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation, 13(3), 283-6. https://doi.org/10.6002/ect.2013.0286
Klein F, et al. Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy. Exp Clin Transplant. 2015;13(3):283-6. PubMed PMID: 24779678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy. AU - Klein,Fritz, AU - Neuhaus,Ruth, AU - Hofmann,Jörg, AU - Rudolph,Birgit, AU - Neuhaus,Peter, AU - Bahra,Marcus, Y1 - 2014/04/28/ PY - 2014/5/1/entrez PY - 2014/5/2/pubmed PY - 2016/3/28/medline SP - 283 EP - 6 JF - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation JO - Exp Clin Transplant VL - 13 IS - 3 N2 - OBJECTIVES: Hepatitis E virus infection is increasingly reported as a cause of chronic hepatitis in organ transplant recipients. Besides reduction of immunosuppressive therapy or pegylated-interferon therapy, promising results have been reported for ribavirin monotherapy of hepatitis E virus after kidney transplant. To our knowledge, this is the first report of a successful ribavirin monotherapy for chronic hepatitis E virus infection after and orthotopic liver transplant. MATERIALS AND METHODS: This is a case report of a 55-year-old man with a diagnosis of chronic hepatitis E (genotype 3f) 26 months after an orthotopic liver transplant. A reduction of immunosuppressive therapy was not tolerated, and the patient did not qualify for pegylated-interferon therapy. Because of progressively elevated liver transaminases accompanied by histologic changes in the liver allograft, ribavirin monotherapy was undertaken for 16 weeks. RESULTS: We saw a decrease in liver enzymes after 1 week of ribavirin monotherapy. Hepatitis E virus RNA anti-HEV-IgM were tested after 8 weeks of ribavirin therapy, and were both negative. Antiviral therapy was continued for 16 weeks, and hepatitis E virus RNA remained undetectable; there also was a significant decrease in liver transaminases levels to normal values. In the 8-week and 8-month follow-ups at the end of antiviral therapy, the patient presented with normal liver enzymes and no detectable hepatitis E virus RNA. CONCLUSIONS: In conclusion, successful therapy of chronic hepatitis E after an orthotopic liver transplant may be achieved by ribavirin monotherapy and should be considered in patients who are sensitive to a reduction of immunosuppressive therapy or pegylated-interferon therapy. SN - 2146-8427 UR - https://www.unboundmedicine.com/medline/citation/24779678/Successful_Treatment_of_Chronic_Hepatitis_E_After_an_Orthotopic_Liver_Transplant_With_Ribavirin_Monotherapy_ L2 - http://www.ectrx.org/forms/ectrxcontentshow.php?year=2015&volume=13&issue=3&supplement=0&makale_no=0&spage_number=283&content_type=FULL TEXT DB - PRIME DP - Unbound Medicine ER -