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Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting.
Transpl Infect Dis. 2015 Aug; 17(4):617-22.TI

Abstract

The chronic course of hepatitis E virus (HEV) infections in orthotopic liver transplant (OLT) recipients has been described previously, but prospectively collected data are rare. We aimed to study the role of chronic hepatitis E in OLT in a real-life setting. Therefore, 287 adult OLT recipients (169 male [59%], median age 56 years) were prospectively tested by HEV polymerase chain reaction assay (lower level of detection = 10 IU/mL), irrespective of their level of liver enzymes. In 4 patients (1.4%), chronic HEV infection was diagnosed. All 4 patients were male, and their age (median 48.5 years), the time since transplantation (median 45.5 months), and bilirubin level (median 0.6 mg/dL) did not differ significantly from the total cohort. However, alanine transaminase and aspartame transaminase levels were significantly higher in HEV-infected patients (75-646 U/L, median 216 U/L and 68-317 U/L, median 108 U/L) than in non-infected patients (6-617 U/L, median 41 and 6-355 U/L, median 36; P = 0.004 and 0.040, Mann-Whitney test). In 3 patients, liver biopsy was performed and revealed signs of inflammation and chronic liver disease, as enlarged densely infiltrated portal tracts with mild-to-moderate interface hepatitis. All infected patients were treated with ribavirin with the starting dose adjusted to renal function (400-800 mg/day). In 2 patients, dose reduction was necessary. Transaminases normalized in all 4 patients, and all patients cleared their infection within 3 months of ribavirin treatment. However, 1 patient experienced viral relapse 12 weeks after discontinuation. Ribavirin medication was re-started and viral clearance occurred within 8 weeks and persisted. Sequence analysis of the HEV genome of this patient revealed that he was infected with an HEV variant, which recently has been shown to have a reduced response to ribavirin in cell culture. The risk of chronic HEV infections in OLT recipients in low-endemic countries should not be overestimated. No case of chronic hepatitis E was observed in patients with normal liver enzymes, indicating that general screening of all OLT recipients is not necessary. However, if chronic hepatitis E develops, it can be treated efficiently with ribavirin.

Authors+Show Affiliations

Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26094550

Citation

Galante, A, et al. "Relevance of Chronic Hepatitis E in Liver Transplant Recipients: a Real-life Setting." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 17, no. 4, 2015, pp. 617-22.
Galante A, Pischke S, Polywka S, et al. Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting. Transpl Infect Dis. 2015;17(4):617-22.
Galante, A., Pischke, S., Polywka, S., Luetgehethmann, M., Suneetha, P. V., Gisa, A., Hiller, J., Dienes, H. P., Nashan, B., Lohse, A. W., & Sterneck, M. (2015). Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 17(4), 617-22. https://doi.org/10.1111/tid.12411
Galante A, et al. Relevance of Chronic Hepatitis E in Liver Transplant Recipients: a Real-life Setting. Transpl Infect Dis. 2015;17(4):617-22. PubMed PMID: 26094550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting. AU - Galante,A, AU - Pischke,S, AU - Polywka,S, AU - Luetgehethmann,M, AU - Suneetha,P V, AU - Gisa,A, AU - Hiller,J, AU - Dienes,H P, AU - Nashan,B, AU - Lohse,A W, AU - Sterneck,M, Y1 - 2015/07/14/ PY - 2014/12/11/received PY - 2015/03/12/revised PY - 2015/04/13/revised PY - 2015/05/21/accepted PY - 2015/6/23/entrez PY - 2015/6/23/pubmed PY - 2016/5/12/medline KW - chronic hepatitis E KW - liver transplant recipients KW - real-life setting KW - ribavirin KW - screening KW - treatment SP - 617 EP - 22 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 17 IS - 4 N2 - The chronic course of hepatitis E virus (HEV) infections in orthotopic liver transplant (OLT) recipients has been described previously, but prospectively collected data are rare. We aimed to study the role of chronic hepatitis E in OLT in a real-life setting. Therefore, 287 adult OLT recipients (169 male [59%], median age 56 years) were prospectively tested by HEV polymerase chain reaction assay (lower level of detection = 10 IU/mL), irrespective of their level of liver enzymes. In 4 patients (1.4%), chronic HEV infection was diagnosed. All 4 patients were male, and their age (median 48.5 years), the time since transplantation (median 45.5 months), and bilirubin level (median 0.6 mg/dL) did not differ significantly from the total cohort. However, alanine transaminase and aspartame transaminase levels were significantly higher in HEV-infected patients (75-646 U/L, median 216 U/L and 68-317 U/L, median 108 U/L) than in non-infected patients (6-617 U/L, median 41 and 6-355 U/L, median 36; P = 0.004 and 0.040, Mann-Whitney test). In 3 patients, liver biopsy was performed and revealed signs of inflammation and chronic liver disease, as enlarged densely infiltrated portal tracts with mild-to-moderate interface hepatitis. All infected patients were treated with ribavirin with the starting dose adjusted to renal function (400-800 mg/day). In 2 patients, dose reduction was necessary. Transaminases normalized in all 4 patients, and all patients cleared their infection within 3 months of ribavirin treatment. However, 1 patient experienced viral relapse 12 weeks after discontinuation. Ribavirin medication was re-started and viral clearance occurred within 8 weeks and persisted. Sequence analysis of the HEV genome of this patient revealed that he was infected with an HEV variant, which recently has been shown to have a reduced response to ribavirin in cell culture. The risk of chronic HEV infections in OLT recipients in low-endemic countries should not be overestimated. No case of chronic hepatitis E was observed in patients with normal liver enzymes, indicating that general screening of all OLT recipients is not necessary. However, if chronic hepatitis E develops, it can be treated efficiently with ribavirin. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/26094550/Relevance_of_chronic_hepatitis_E_in_liver_transplant_recipients:_a_real_life_setting_ L2 - https://doi.org/10.1111/tid.12411 DB - PRIME DP - Unbound Medicine ER -