Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy.
OBJECTIVE
Hepatitis E virus infection is increasingly reported as a cause of chronic hepatitis in organ transplant recipients. Besides reduction of immunosuppressive therapy or pegylated-interferon therapy, promising results have been reported for ribavirin monotherapy of hepatitis E virus after kidney transplant. To our knowledge, this is the first report of a successful ribavirin monotherapy for chronic hepatitis E virus infection after and orthotopic liver transplant.


METHODS
This is a case report of a 55-year-old man with a diagnosis of chronic hepatitis E (genotype 3f) 26 months after an orthotopic liver transplant. A reduction of immunosuppressive therapy was not tolerated, and the patient did not qualify for pegylated-interferon therapy. Because of progressively elevated liver transaminases accompanied by histologic changes in the liver allograft, ribavirin monotherapy was undertaken for 16 weeks.


RESULTS
We saw a decrease in liver enzymes after 1 week of ribavirin monotherapy. Hepatitis E virus RNA anti-HEV-IgM were tested after 8 weeks of ribavirin therapy, and were both negative. Antiviral therapy was continued for 16 weeks, and hepatitis E virus RNA remained undetectable; there also was a significant decrease in liver transaminases levels to normal values. In the 8-week and 8-month follow-ups at the end of antiviral therapy, the patient presented with normal liver enzymes and no detectable hepatitis E virus RNA.


CONCLUSIONS
In conclusion, successful therapy of chronic hepatitis E after an orthotopic liver transplant may be achieved by ribavirin monotherapy and should be considered in patients who are sensitive to a reduction of immunosuppressive therapy or pegylated-interferon therapy.
From the Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Institute of Medical Virology, Helmut-Ruska-Haus, Berlin, Germany.
Fritz
F
Klein
Ruth
R
Neuhaus
Jörg
J
Hofmann
Birgit
B
Rudolph
Peter
P
Neuhaus
Marcus
M
Bahra
D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006521:Hepatitis, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012254:Ribavirin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012254:Ribavirin