Choi Mira, Hofmann Jörg, Köhler Anja, Wang Bo, Bock Claus-Thomas, Schott Eckart, Reinke Petra, Nickel Peter
Department of Nephrology and Intensive Care, Charité Universitätsmedizin Berlin, Germany.
Labor Berlin, Charité-Vivantes GmbH, Berlin, Germany.
Transplant Direct. 2018 Feb 2;4(2):e341. doi: 10.1097/TXD.0000000000000758. eCollection 2018 Feb.
Elevated liver enzymes are frequently observed in renal transplant recipients and warrant further exploration. In immunosuppressed patients, hepatitis E virus (HEV) infection may cause chronic hepatitis, cirrhosis, and extrahepatic manifestations such as renal injury.
We performed a retrospective cross-sectional study investigating the prevalence, clinical correlates, and outcome of chronic HEV infection in a cohort of renal transplant recipients with elevated liver enzymes.
Over a period of 30 months, 140 of 1469 renal transplant recipients had elevated liver enzymes, of which serum samples from 98 patients were available to determine HEV status. Seventeen patients were detected with HEV infection, of which 16 developed chronic HEV infection, while 1 patient controlled viremia (prevalence of chronic infection of 16.3%, with a minimum prevalence of 1.1% in the whole cohort). Increased liver stiffness was indicated by an average FibroScan result of 11.2 kPa in these patients. All 16 patients with chronic HEV infection were treated with ribavirin for a mean duration of 3 months. Five patients developed a viral rebound and received a second treatment course, of which 2 controlled HEV replication. Six months after the end of therapy, HEV clearance was achieved in 81.3% of the patients. One patient developed ribavirin resistance. Hemolytic anemia after ribavirin treatment was frequent, requiring blood transfusion in 3 patients. Four patients developed de novo glomerulonephritis, of which 2 were possibly associated with HEV infection.
This retrospective study showed that prevalence of chronic HEV infection was high in our renal transplant patient cohort and was associated with significant liver impairment and the occurrence of renal injury. Ribavirin treatment was effective and should be initiated early to avoid complications, but the risk of severe hemolytic anemia makes strict monitoring essential.
肾移植受者中经常观察到肝酶升高，需要进一步探究。在免疫抑制患者中，戊型肝炎病毒（HEV）感染可能导致慢性肝炎、肝硬化以及肾损伤等肝外表现。
我们进行了一项回顾性横断面研究，调查一组肝酶升高的肾移植受者中慢性HEV感染的患病率、临床相关性及转归。
在30个月的时间里，1469例肾移植受者中有140例肝酶升高，其中98例患者的血清样本可用于确定HEV状态。检测到17例患者感染HEV，其中16例发展为慢性HEV感染，1例病毒血症得到控制（慢性感染患病率为16.3%，全队列最低患病率为1.1%）。这些患者的平均FibroScan结果显示肝脏硬度增加，为11.2 kPa。所有16例慢性HEV感染患者均接受了利巴韦林治疗，平均疗程为3个月。5例患者出现病毒反弹并接受了第二个疗程的治疗，其中2例控制了HEV复制。治疗结束6个月后，81.3%的患者实现了HEV清除。1例患者出现利巴韦林耐药。利巴韦林治疗后溶血性贫血很常见，3例患者需要输血。4例患者发生了新发肾小球肾炎，其中2例可能与HEV感染有关。
这项回顾性研究表明，我们的肾移植患者队列中慢性HEV感染的患病率很高，且与严重肝损伤和肾损伤的发生有关。利巴韦林治疗有效，应尽早开始以避免并发症，但严重溶血性贫血的风险使得严格监测至关重要。
