Non-travel related Hepatitis E virus (HEV) hepatitis is an under diagnosed emerging infection in developed countries. The screening of healthy blood donors in the Netherlands recently showed an overall seroprevalence of 27%. Due to its asymptomatic course it remains unrecognized in the general population, but can be of great clinical importance in immune-compromised patients such as solid-organ transplant (SOT) recipients. Increasing numbers of reports show that HEV genotype 3 infection can cause chronic hepatitis in SOT recipients. This chronic hepatitis may lead to rapidly progressive cirrhosis, necessitating early therapeutic intervention.
Since the second half of 2007, SOT recipients with unexplained hepatitis were screened for HEV and clinical data were collected. HEV was further characterized by sequencing.
In total 24 SOT recipients, presenting with elevated ALTs, tested positive for HEV RNA genotype 3. Of these 6 were lung-, 1 heart-, 6 liver- and 9 kidney-transplant recipients; 2 received multiple SOTs. At the time of HEV detection, most patients showed elevated ALT, ranging from 36-1001U/L (median of 112U/L). A chronic infection could be diagnosed in 15 of these 24 SOT recipients (62,5%). Five SOT recipients, were able to resolve the infection within 6 months upon reduction of immunosuppression. So far, 13 SOT recipients were successfully treated. Two liver transplant patients were treated with pegylated interferon alpha-2b. In addition, eleven SOT recipients were treated with oral ribavirin.
Early recognition of HEV infection as a cause of post transplant hepatitis is crucial to minimize liver damage and may play a role in clinical decision making. An increasing awareness of the existence of chronic HEV infection among transplant clinicians and medical microbiologists is needed.
Low grade liver function test abnormalities after SOT should trigger suspicion of chronic HEV infection. The favorable outcome upon antiviral treatment in 11 SOT recipients suggests that oral ribavirin might be an effective treatment of chronic HEV infection. However, further studies are needed to investigate the effectiveness and optimal duration of antiviral treatment in different groups of SOT recipients.
J. S. Sanders, None
E. Verschuuren, None
B. Niesters, None