Influence of Immunosuppressive Therapy on the Natural History of Genotype 3 Hepatitis-E Virus Infection After Organ Transplantation

Abstract

The rate of chronic HEV-related hepatitis is approximately 60% in solid-organ transplant patients. When possible, the reduction of immunosuppressive drugs targeting T cells should be considered as a first-line therapeutic option.

Molecular detection of hepatitis E virus (HEV) in liver biopsies after liver transplantation

“…In the later course of infection, typical histological features of chronic viral hepatitis such as predominantly portal inflammation and progressive fibrosis were found. 14,16,28 Our observations illustrate that not only clinical presentation, but also liver histology in cases of HEV under immunosuppression is far from characteristic or even specific. Therefore, histological findings consistent with viral hepatitis should prompt diagnostic workup for HEV.…”

Chronic Hepatitis E Virus Infection and Treatment

“…11,12,14,18,[36][37][38][39][40][41][42][43][44][45][46][47][48] A large multicenter retrospective study, which included 85 adult patients with a SOT (kidney-, liver-, kidney-pancreas-, islet-, heart-, and lung-transplants) showed that 34.1% had spontaneous clearance of HEV within the first 6 months after HEV was diagnosed and no HEV reactivation later on, whereas 65.9% developed chronic hepatitis. 49 Interestingly, in contrast to non-immunosuppressed patients who usually present to hospital with jaundice, 50 when HEV was diagnosed, only 32% of patients were symptomatic.…”

“…49 Several other cases of HEVinduced cirrhosis have been reported. 12,18,33,[36][37][38]40,49 In one study, liver fibrosis rapidly evolved in transplant patients who were chronically infected by HEV, and this led to decompensated cirrhosis and death. 40 Slow HEV quasispecies diversification during the first year after infection has been associated with rapidly developing liver fibrosis.…”

“…40,49 A few liver-transplant patients with chronic HEV infection were given a 3-month (n = 3) or a 12-month (n = 1) course of pegylated interferon (135 mg/ week): a sustained virological response was observed in three of the four patients. 54,55 In vitro, it has been shown that HEV downregulates IFN-a-induced gene expression.…”

Hepatitis E virus infection in Iranian kidney-transplant patients

“…In the past several years, HEV infection in organ transplant patients has garnered much interest. After kidney transplantation, HEV-related liver fibrosis can lead rapidly to cirrhosis [5]. The use of tacrolimus, rather than cyclosporine A, and a low platelet count at HEV diagnosis have been identified as predictive factors for chronic HEV infection [6].…”