Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients

Kamar, Nassim; Izopet, Jacques; Tavecchio, Simona; Bismuth, Michaël; Hillaire, Sophie; Dumortier, Jérôme; Radenne, Sylvie; Coilly, Audrey; Garrigue, Valérie; d’Altéroche, Louis; Büchler, Matthias; Couzi, Lionel; Lebray, Pascal; Dharancy, Sébastien; Minello, Anne; Hourmant, Maryvonne; Roque–Afonso, Anne–Marie; Abravanel, Florence; Pol, Stanislas; Rostaing, Lionel; Mallet, Vincent

doi:10.1056/nejmoa1215246

Cited by 446 publications

(423 citation statements)

References 40 publications

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“…6 Ribavirin (RBV) monotherapy is the treatment-of-choice for most patients. 7,8 However, treatment failure has been observed, either as a partial response to ribavirin or viral recurrence after therapy cessation, and is possibly linked to dose reductions because of severe anemia in some cases. 7,8 We report on 15 solid-organ-transplant patients with chronic hepatitis E (11 with genotype 3c, 3 genotype 3f and 1 genotype 3e).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…7,8 However, treatment failure has been observed, either as a partial response to ribavirin or viral recurrence after therapy cessation, and is possibly linked to dose reductions because of severe anemia in some cases. 7,8 We report on 15 solid-organ-transplant patients with chronic hepatitis E (11 with genotype 3c, 3 genotype 3f and 1 genotype 3e). RBV treatment was successful in all but 2 patients (both genotype 3c) who failed to clear the virus (13%, which is comparable to other studies reporting failure rates of 15-18%).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…RBV treatment was successful in all but 2 patients (both genotype 3c) who failed to clear the virus (13%, which is comparable to other studies reporting failure rates of 15-18%). 7,8 The first patient was a male heart/kidney-recipient who was treated for 9 months and showed an initial decrease in viral RNA load upon initiation of RBV treatment but never became HEV RNA negative (i.e. below 1000 copies/mL, Figure 1A).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

See 2 more Smart Citations

A Mutation in the Hepatitis E Virus RNA Polymerase Promotes Its Replication and Associates With Ribavirin Treatment Failure in Organ Transplant Recipients

et al. 2014

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

A Mutation in the Hepatitis E Virus RNA Polymerase Promotes Its Replication and Associates With Ribavirin Treatment Failure in Organ Transplant Recipients

et al. 2014

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“…A recent retrospective, multicenter study showed that ribavirin monotherapy (600 mg daily) for 3 months may be effective in the treatment of chronic HEV infection. 140 …”

Section: Hepatitis E Virusmentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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“…Ribavirin is recognized to achieve virological clearance in 78% of immunosuppressed patients with chronic hepatitis E. 4 The use of ribavirin in acute hepatitis E is less well described and is limited to case reports (Table 1). [5][6][7][8][9] On review of the literature, 9 patients with acute HEV have been treated with ribavirin for median duration of 7 weeks (10 days to 24 weeks) with median time to virological clearance of 4 weeks (3-8 weeks).…”

mentioning

confidence: 99%

Liver transplantation for acute liver failure because of genotype 3 hepatitis E virus infection

et al. 2015

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Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients

Abstract: This retrospective, multicenter study showed that ribavirin as monotherapy may be effective in the treatment of chronic HEV infection; a 3-month course seemed to be an appropriate duration of therapy for most patients.

Cited by 446 publications

References 40 publications

A Mutation in the Hepatitis E Virus RNA Polymerase Promotes Its Replication and Associates With Ribavirin Treatment Failure in Organ Transplant Recipients

A Mutation in the Hepatitis E Virus RNA Polymerase Promotes Its Replication and Associates With Ribavirin Treatment Failure in Organ Transplant Recipients

Infections After Orthotopic Liver Transplantation

Liver transplantation for acute liver failure because of genotype 3 hepatitis E virus infection

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