Prevalence and clinical consequences of Hepatitis E in patients who underwent liver transplantation for chronic Hepatitis C in the United States

Abstract

BackgroundInfection with hepatitis E virus (HEV) in immunocompromised patients can lead to severe liver disease. Treatment options for HEV include peginterferon or ribavirin, routinely also used for the treatment of hepatitis C virus (HCV) infection.We determined the prevalence and clinical consequences of HEV in United States (US) based patients who underwent liver transplantation (LT) for chronic HCV.MethodsSeroprevalence of HEV in 145 US LT recipients with a history of chronic HCV was determined pre-LT, 1, 3 and 5 years post-LT. All last available samples and all samples in IgM positive patients and post-LT IgG seroconverters were tested for HEV RNA.ResultsOverall anti-HEV seroprevalence was 42 %. Five patients were HEV IgM positive pre-LT, one patient had IgM seroconversion post-LT and eight patients had IgG seroconversion post-LT. None of the tested samples were positive for HEV RNA. Eight out of nine of the post-LT seroconverters had been treated for HCV recurrence before or at the moment of seroconversion.ConclusionsLT recipients in the US are at risk of acquiring HEV. Post-LT HCV treatment with interferons and/or ribavirin may have protected patients against chronic HEV. With the arrival of new direct antiviral agents for the treatment of HCV and the elimination of peginterferon and ribavirin from HCV treatment regimens, the prevalence of chronic HEV in this population may rise again.

Hepatitis E virus genotype 3 is a common finding in liver‐transplanted patients undergoing liver biopsy for elevated liver enzymes with a low De Ritis ratio and suspected acute rejection: A real‐world cohort

“…In the recent years, increasing numbers of hepatitis E virus (HEV) infections were recognized as a reason for elevated liver enzymes after LT. Seroepidemiologic studies in representative samples of the German adult population have found an overall HEV antibody prevalence of approximately 17% . The seroprevalence in patients who underwent LT for hepatitis C (HCV) is up to 40% within 5 years post‐LT . In 287 asymptomatic adult LT patients, four cases (1.6%) of chronic HEV infection were found in a prospective screening .…”

Hepatitis E Virus Infection in the United States: Current Understanding of the Prevalence and Significance in the Liver Transplant Patient Population and Proposed Diagnostic and Treatment Strategies

“…( 23 ) Koning et al determined the prevalence of HEV infection in patients who underwent LT for chronic viral hepatitis C in Rochester, MN. ( 24 ) Nearly 40% of the 145 patients with hepatitis C virus–associated cirrhosis were HEV IgG–positive prior to receiving a transplant. This study merely noted the prevalence of HEV exposure prior to LT and rates of seroconversion after LT, but it did not provide data on the development of chronic or acute infection.…”

“…In studies that examine HEV in the SOT population, the seroprevalence of HEV IgG is reported but many patients do not have evidence of chronic HEV infection (ie, HEV RNA in blood or stool for at least 6 months). ( 23,24 ) An improved understanding of the seroprevalence of HEV in the United States could impact on care of SOT patients. Those patients in areas of higher prevalence would potentially be at greater risk of exposure to HEV and, thus, have a higher risk of developing chronic HEV infection.…”

HCV and HEV recurrence after liver transplantation: one antiviral therapy for two viruses

“…The HEV diagnosis cannot be made on liver biopsy, due to the prevalence of HCV histological features; thus, HEV needs to be systematically tested in case of increase in transaminases. Moreover, since serology is not sensitive enough [1], HEV PCR should be always tested.Third, a three-month course of RBV remains the recommended treatment for chronic HEV infection, with a SVR of 78% [3]. Dao Thi et al [4] showed that SOF inhibited HEV-RNA replication in vitro and had an additive effect with RBV, but these findings need to be clinically validated.…”

“…Third, a three-month course of RBV remains the recommended treatment for chronic HEV infection, with a SVR of 78% [3]. Dao Thi et al [4] showed that SOF inhibited HEV-RNA replication in vitro and had an additive effect with RBV, but these findings need to be clinically validated.…”