title: Hepatitis E virus infection results in acute graft failure after liver transplantation: a case report.
abstract: Hepatitis E virus (HEV) infection in most individuals is known as a self-limiting, acute, icteric hepatitis, but evidence shows HEV is responsible for choric hepatitis and rapid progressed liver cirrhosis in immuno-compromised patients. We present the case of a patient whose diagnosis of acute graft failure was due to a HEV infection 7 years after his first liver transplantation because of Wilson's disease. The process showed severe jaundice with fatigue, poor appetite and continually rising serum aminopherase. The blood serum was found positive for the anti-HEV IgG antibody but negative for anti-HEV IgM or other infections. Cholangiole cholestasis was detected in graft biopsy. Triple hepato-protective drugs (Transmetil, Polyene Phosphatidylcholine, and Compound Ammonium Glycyrrhetate S) alongside five times Artificial Liver Support System (ALSS) did not improve the patient's condition, but the total bilirubin level rose to more than 900umol/L. So re-transplantation was performed. Blood testing shows normal liver enzymes and bilirubin with persisting anti-HEV IgG antibody positive at the 3-month follow-up.
authors: First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. cuckooxy@zju.edu.cn.
authors: Xiangyan
authors: X
authors: Liu
authors: Tian
authors: T
authors: Shen
authors: Zhuoyi
authors: Z
authors: Wang
authors: Li
authors: L
authors: Zhuang
authors: Wei
authors: W
authors: Zhang
authors: Jun
authors: J
authors: Yu
authors: Jian
authors: J
authors: Wu
authors: Shusen
authors: S
authors: Zheng
mesh_terms: D000208:Acute Disease; D000410:Alanine Transaminase / Q000378:metabolism; D000914:Antibodies, Viral / Q000097:blood; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D002681:China; D006084:Graft Rejection / Q000821:virology*; D016751:Hepatitis E / Q000175:diagnosis*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000637:Transaminases; C019690:aminopherase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin