title: Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) infection can cause chronic hepatitis in recipients of solid organ transplants. However, the factors that contribute to chronic infection and the outcomes of these patients are incompletely understood. We performed a retrospective analysis of data from 17 centers from Europe and the United States that described the progression, outcomes, and factors associated with development of chronic HEV infection in recipients of transplanted solid organs.
  
  
  METHODS
  We studied data from 85 recipients of solid organ transplants who were infected with HEV. Chronic HEV infection was defined by the persistent increases in levels of liver enzymes and polymerase chain reaction evidence of HEV in the serum and/or stool for at least 6 months.
  
  
  RESULTS
  Fifty-six patients (65.9%) developed chronic hepatitis. Univariate analysis associated liver transplant, shorter times since transplant, lower levels of liver enzymes and serum creatinine, lower platelet counts, and tacrolimus-based immunosuppressive therapy (rather than cyclosporin A) with chronic hepatitis. On multivariate analysis, the independent predictive factors associated with chronic HEV infection were the use of tacrolimus rather than cyclosporin A (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.49-1.97; P = .004) and a low platelet count at the time of diagnosis with HEV infection (OR, 1.02; 95% CI, 1.001-1.1; P = .04). Of patients with chronic hepatitis, 18 (32.1%) achieved viral clearance after the dose of immunosuppressive therapy was reduced. No HEV reactivation was observed after HEV clearance.
  
  
  CONCLUSIONS
  HEV infection causes chronic hepatitis in more than 60% of recipients of solid organ transplants. Tacrolimus therapy is the main predictive factor for chronic hepatitis. Dose reductions of immunosuppressive therapy resulted in viral clearance in more than 30% of patients.
authors.affiliation: Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.fr
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Cyril
authors.initials: C
authors.lastname: Garrouste
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Haagsma
authors.forename: Valérie
authors.initials: V
authors.lastname: Garrigue
authors.forename: Sven
authors.initials: S
authors.lastname: Pischke
authors.forename: Cécile
authors.initials: C
authors.lastname: Chauvet
authors.forename: Jérome
authors.initials: J
authors.lastname: Dumortier
authors.forename: Amélie
authors.initials: A
authors.lastname: Cannesson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassuto-Viguier
authors.forename: Eric
authors.initials: E
authors.lastname: Thervet
authors.forename: Filomena
authors.initials: F
authors.lastname: Conti
authors.forename: Pascal
authors.initials: P
authors.lastname: Lebray
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: Robert
authors.initials: R
authors.lastname: Santella
authors.forename: Nada
authors.initials: N
authors.lastname: Kanaan
authors.forename: Marie
authors.initials: M
authors.lastname: Essig
authors.forename: Christiane
authors.initials: C
authors.lastname: Mousson
authors.forename: Sylvie
authors.initials: S
authors.lastname: Radenne
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Roque-Afonso
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000328:Adult; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016751:Hepatitis E / Q000821:virology*; D016752:Hepatitis E virus / Q000235:genetics*; D006521:Hepatitis, Chronic / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000235:genetics*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral