Course and treatment of chronic hepatitis E virus infection in lung transplant recipients.
OBJECTIVE
Persistent hepatitis E virus (HEV) infections have been described in various transplant cohorts. However, the frequency and the course of HEV infection in lung transplant recipients (Lu-Tr) are not well defined.


METHODS
We retrospectively analyzed serum from 95 Lu-Tr for HEV RNA and anti-HEV immunoglobulin-G (IgG) (with the MP assay). Anti-HEV seroprevalence was compared to that of 537 healthy individuals. Prospective HEV screening was subsequently initiated in Lu-Tr.


RESULTS
Elevated liver enzymes were observed in 44/95 (46.3%) patients. Anti-HEV IgG was present in 5/95 patients (5.3%), revealing a slightly higher prevalence compared to controls (2%, 11/537; P = 0.07). Chronic HEV infection with detectable viral replication was confirmed by polymerase chain reaction in 3 (3.2%) patients, all of whom demonstrated clinical and biochemical features of active liver disease (maximum alanine aminotransferase [ALTmax ] 89, 215, and 270 IU/L, respectively). One patient had died from multi-organ failure in combination with liver cirrhosis before HEV diagnosis. Two additional patients with chronic hepatitis E were identified during prospective screening (ALTmax 359 and 318 IU/L). All patients still alive commenced ribavirin therapy for 5 months, with dose adjustment (400-600 mg/day) according to renal function and hemoglobin level. Sustained resolution of HEV infection occurred in 2 patients. One patient is still under treatment, and the fourth died from graft failure considered unrelated to ribavirin therapy.


CONCLUSIONS
Chronic hepatitis E should be considered in the differential diagnosis of elevated liver enzymes, which are commonly seen in Lu-Tr. We observed 1 case of end-stage liver cirrhosis and death in an HEV-infected subject, who was not treated with ribavirin. Given this potentially devastating consequence, ribavirin therapy of persistent HEV infection appears to be acceptably safe and effective in Lu-Tr. However, larger prospective studies are warranted.
Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; IFB-TX, Hannover, Germany.
S
S
Pischke
M
M
Greer
S
S
Hardtke
B
B
Bremer
A
A
Gisa
P
P
Lehmann
A
A
Haverich
T
T
Welte
M P
MP
Manns
H
H
Wedemeyer
J
J
Gottlieb
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D016751:Hepatitis E / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D016752:Hepatitis E virus / Q000276:immunology* / Q000502:physiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D016036:Seroepidemiologic Studies; D014779:Virus Replication; D055815:Young Adult
D000998:Antiviral Agents; D007074:Immunoglobulin G; D012367:RNA, Viral; D012254:Ribavirin; D000410:Alanine Transaminase
chronic infection; hepatitis E; lung transplantation