Allaire M, Bazille C, Selves J, Salamé E, Altieri M
Service d'hépato-gastroentérologie, CHU Côte-de-Nacre, Caen, France.
Service d'anatomopathologie, CHU Côte-de-Nacre, Caen, France.
Clin Res Hepatol Gastroenterol. 2018 Sep;42(4):e68-e71. doi: 10.1016/j.clinre.2017.12.005. Epub 2018 Apr 10.
In liver transplant (LT) patients, hepatitis E virus (HEV) can lead to acute liver failure, chronic hepatitis and graft cirrhosis. Few data on graft rejection associated with HEV are available and are subject to discussion.
Here we report the case of a 58-year-old male patient who underwent LT in July 2015 for cirrhosis due to NASH and chronic alcohol intake complicated by hepatocellular carcinoma. LT was performed with a deceased donor isogroup and a mismatch CMV (donor+ and recipient-). HEV serology was negative before LT. In February 2016, we noted abnormal liver function, with increased transaminases and cholestasis parameters, without functional complaints. The patient was immunosuppressed by tacrolimus (4mg) and everolimus (2mg). Abdominal ultrasound was normal and liver biopsy showed signs of acute rejection (Banff score 6/9). We dispensed 500mg of methylprednisolone before obtaining positive serological results for HEV genotype 3 infection. Ribavirin (1,200mg per day) for 3 months was started, leading to rapid improvement in liver tests. Viral load became negative one month later. To date, the patient is under LP 5mg tacrolimus with normal liver tests.
We describe a case of HEV genotype 3 infection mimicking acute cellular rejection, with a favorable outcome due to ribavirin treatment. As intensive immunosuppressive therapy administered for graft rejection may promote viral replication and worsen liver damage, potential HEV infection must be considered in cases of pathological signs of acute cellular rejection, in order to avoid chronic graft hepatitis, cirrhosis and liver decompensation.
在肝移植（LT）患者中，戊型肝炎病毒（HEV）可导致急性肝衰竭、慢性肝炎和移植肝肝硬化。关于与HEV相关的移植排斥反应的数据很少，且存在争议。
我们在此报告一例58岁男性患者，该患者于2015年7月因非酒精性脂肪性肝炎（NASH）和慢性酒精摄入合并肝细胞癌导致的肝硬化接受肝移植。肝移植采用已故供体同型组且巨细胞病毒（CMV）不匹配（供体阳性和受体阴性）。肝移植前HEV血清学检查为阴性。2016年2月，我们注意到肝功能异常，转氨酶和胆汁淤积参数升高，但无功能主诉。患者接受他克莫司（4mg）和依维莫司（2mg）免疫抑制治疗。腹部超声正常，肝活检显示急性排斥反应迹象（班夫评分6/9）。在获得HEV 3型感染的阳性血清学结果之前，我们给予了500mg甲泼尼龙。开始使用利巴韦林（每天1200mg）治疗3个月，肝功能检查迅速改善。1个月后病毒载量转阴。迄今为止，患者接受5mg他克莫司治疗，肝功能检查正常。
我们描述了一例模仿急性细胞排斥反应的HEV 3型感染病例，经利巴韦林治疗后预后良好。由于针对移植排斥反应进行的强化免疫抑制治疗可能会促进病毒复制并加重肝损伤，因此在出现急性细胞排斥反应的病理迹象时，必须考虑潜在的HEV感染，以避免慢性移植肝炎、肝硬化和肝失代偿。
