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Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients.
Pediatr Nephrol. 2018 07; 33(7):1215-1225.PN

Abstract

BACKGROUND

Hepatitis E virus (HEV) infection in immunocompromised patients such as solid organ transplant recipients may bear a high risk of becoming a chronic infection with progression to liver cirrhosis. So far, data on HEV infection in pediatric renal transplant recipients are limited.

METHODS

This single-center cohort study investigated period prevalence, morbidity, and treatment of HEV infection in 90 pediatric renal allograft recipients aged 9.9 ± 5.6 years at transplantation (58.9% males). HEV serology was determined by enzyme-linked immunosorbent assay and immunoblot, HEV replication by quantitative nucleic acid testing.

RESULTS

Twelve of 90 (13.3%) patients were HEV seropositive, and 4/90 (4.4%) recipients showed active HEV replication (103-108 copies/mL, corresponding to 0.5 × 103 and 0.5 × 108 WHO IU/mL) in serum and stool. In all patients with HEV replication, genotype 3 was identified by partial sequencing of HEV ORF1 and ORF2 and phylogenetic analysis. All patients with HEV replication developed chronic infection associated with moderately elevated liver enzymes. HEV replication was unresponsive to reduction of immunosuppression, whereas ribavirin monotherapy (mean dosage 9.7 ± 3.6 mg/kg per day over 85 ± 11 days) was associated with sustained viral clearance and normalization of liver enzymes in all patients. Ribavirin therapy was associated with reversible, hyporegenerative anemia.

CONCLUSIONS

Given an HEV seroprevalence of 13.3% in pediatric renal transplant recipients and an HEV viremia of 4.4%, HEV infection should be considered in patients with otherwise unexplained elevation of liver enzymes. HEV infection does not necessarily respond to reduction of immunosuppressive therapy, but can be effectively and safely treated with ribavirin.

Authors+Show Affiliations

Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Infectious Diseases, Virology, University Hospital of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Franz-Josef-Strauβ-Allee 11, 93053, Regensburg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.Department of Pediatrics I, University Children's Hospital of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. britta.hoecker@med.uni-heidelberg.de.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29500631

Citation

Cordts, Stephanie E., et al. "Prevalence, Morbidity, and Therapy of Hepatitis E Virus Infection in Pediatric Renal Allograft Recipients." Pediatric Nephrology (Berlin, Germany), vol. 33, no. 7, 2018, pp. 1215-1225.
Cordts SE, Schneble L, Schnitzler P, et al. Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients. Pediatr Nephrol. 2018;33(7):1215-1225.
Cordts, S. E., Schneble, L., Schnitzler, P., Wenzel, J. J., Vinke, T., Rieger, S., Fichtner, A., Tönshoff, B., & Höcker, B. (2018). Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients. Pediatric Nephrology (Berlin, Germany), 33(7), 1215-1225. https://doi.org/10.1007/s00467-018-3905-7
Cordts SE, et al. Prevalence, Morbidity, and Therapy of Hepatitis E Virus Infection in Pediatric Renal Allograft Recipients. Pediatr Nephrol. 2018;33(7):1215-1225. PubMed PMID: 29500631.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients. AU - Cordts,Stephanie E, AU - Schneble,Lukas, AU - Schnitzler,Paul, AU - Wenzel,Jürgen J, AU - Vinke,Tobias, AU - Rieger,Susanne, AU - Fichtner,Alexander, AU - Tönshoff,Burkhard, AU - Höcker,Britta, Y1 - 2018/03/02/ PY - 2017/10/10/received PY - 2018/01/25/accepted PY - 2018/01/24/revised PY - 2018/3/4/pubmed PY - 2019/10/3/medline PY - 2018/3/4/entrez KW - Chronic hepatitis KW - Hepatitis E virus KW - Immunosuppression KW - Pediatric renal transplantation KW - Ribavirin SP - 1215 EP - 1225 JF - Pediatric nephrology (Berlin, Germany) JO - Pediatr. Nephrol. VL - 33 IS - 7 N2 - BACKGROUND: Hepatitis E virus (HEV) infection in immunocompromised patients such as solid organ transplant recipients may bear a high risk of becoming a chronic infection with progression to liver cirrhosis. So far, data on HEV infection in pediatric renal transplant recipients are limited. METHODS: This single-center cohort study investigated period prevalence, morbidity, and treatment of HEV infection in 90 pediatric renal allograft recipients aged 9.9 ± 5.6 years at transplantation (58.9% males). HEV serology was determined by enzyme-linked immunosorbent assay and immunoblot, HEV replication by quantitative nucleic acid testing. RESULTS: Twelve of 90 (13.3%) patients were HEV seropositive, and 4/90 (4.4%) recipients showed active HEV replication (103-108 copies/mL, corresponding to 0.5 × 103 and 0.5 × 108 WHO IU/mL) in serum and stool. In all patients with HEV replication, genotype 3 was identified by partial sequencing of HEV ORF1 and ORF2 and phylogenetic analysis. All patients with HEV replication developed chronic infection associated with moderately elevated liver enzymes. HEV replication was unresponsive to reduction of immunosuppression, whereas ribavirin monotherapy (mean dosage 9.7 ± 3.6 mg/kg per day over 85 ± 11 days) was associated with sustained viral clearance and normalization of liver enzymes in all patients. Ribavirin therapy was associated with reversible, hyporegenerative anemia. CONCLUSIONS: Given an HEV seroprevalence of 13.3% in pediatric renal transplant recipients and an HEV viremia of 4.4%, HEV infection should be considered in patients with otherwise unexplained elevation of liver enzymes. HEV infection does not necessarily respond to reduction of immunosuppressive therapy, but can be effectively and safely treated with ribavirin. SN - 1432-198X UR - https://www.unboundmedicine.com/medline/citation/29500631/Prevalence_morbidity_and_therapy_of_hepatitis_E_virus_infection_in_pediatric_renal_allograft_recipients_ L2 - https://dx.doi.org/10.1007/s00467-018-3905-7 DB - PRIME DP - Unbound Medicine ER -