title: Chronic hepatitis E infection in lung transplant recipients.
abstract: BACKGROUND
  Hepatitis E virus (HEV) genotype 3 has been identified in patients with autochthonous HEV infections in developed countries and is currently being recognized as an emerging zoonotic pathogen. HEV infection may lead to a chronic hepatitis in immune-compromised patients.
  
  
  METHODS
  We studied the incidence of HEV in adult lung transplant recipients at the Medical University Vienna and the University Medical Center Groningen. These recipients presented with elevated liver test results during the post-transplant follow-up period. The time of infection was investigated using stored specimens, and the HEV genotype was determined by sequence analysis of the open reading frame (ORF)1 and ORF2 region.
  
  
  RESULTS
  The study included 468 adult lung transplant recipients. Ten patients (2.1%) tested positive for HEV RNA. At the time of HEV detection, all patients had elevated liver test results, with median alanine aminotransferase levels of 77 U/liter and showed a mild hepatitis. A chronic HEV infection was diagnosed in the 8 lung transplant recipients who survived longer than 6 months after transplantation. Viral genotyping revealed only genotype 3 strains. In 2 of the lung transplant recipients treated with oral ribavirin monotherapy, HEV RNA was cleared from the plasma within 2 months with simultaneous normalization of alanine aminotransferase levels.
  
  
  CONCLUSIONS
  Chronic HEV is an important cause of liver test abnormalities after lung transplantation; therefore, routine screening for HEV RNA is strongly recommended in lung transplant recipients. Oral ribavirin appears to be a safe and effective treatment for chronic HEV infection in lung transplant recipients.
authors: Departments of Medical Microbiology, Division of Clinical Virology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors: Annelies
authors: A
authors: Riezebos-Brilman
authors: Elisabeth
authors: E
authors: Puchhammer-Stöckl
authors: Hinke Y
authors: HY
authors: van der Weide
authors: Elizabeth B
authors: EB
authors: Haagsma
authors: Peter
authors: P
authors: Jaksch
authors: Isabella
authors: I
authors: Bejvl
authors: Hubert G
authors: HG
authors: Niesters
authors: Erik A M
authors: EA
authors: Verschuuren
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D016751:Hepatitis E / Q000209:etiology*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies