Ambrocio G P L, Aguado S, Carrillo J, Laporta R, Lazaro-Carrasco M, Avellon A, Aran-Toha G, Ussetti M, Aguilar M
Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
Section of Pulmonary Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
Transplant Proc. 2019 Mar;51(2):376-379. doi: 10.1016/j.transproceed.2018.10.006. Epub 2018 Oct 28.
Hepatitis E virus (HEV) is one of the common causes of acute and chronic viral hepatitis with a global distribution. Genotypes 1 and 2 only affect humans and produce acute hepatitis epidemics in endemic regions (Asia, Africa). In nonendemic areas (America, Europe), genotypes 3 and 4 are considered a zoonosis and cause sporadic acute hepatitis. HEV has been described in solid organ transplant recipients; however, data on lung transplant patients are limited.
To present the first 3 cases of HEV infection in lung transplant recipients in our unit.
We report 3 cases of HEV infection in post-transplant patients presenting with symptoms and alterations in liver enzymes. All patients have no history of travel outside Spain prior to observing abnormalities in the liver function. Diagnoses were made with in-home polymerase chain reaction and enzyme-linked immunosorbent assay (IgG/IgM). The first patient was not treated and died of progressive hepatic disease, with postmortem diagnosis of HEV infection complications. The other 2 patients were treated with ribavirin after the diagnosis of HEV infection. Ribavirin was discontinued in 1 patient because of anemia necessitating red blood cell transfusions.
HEV should be considered in the differential diagnosis of patients with abnormal liver enzymes after transplant. Early detection and treatment have implications in the prevention of liver failure and mortality. Large prospective seroprevalence studies of HEV in lung transplant patients are warranted to recognize the epidemiology of this infection in lung transplant recipients.
戊型肝炎病毒（HEV）是急性和慢性病毒性肝炎的常见病因之一，在全球范围内均有分布。1型和2型仅感染人类，并在流行地区（亚洲、非洲）引发急性肝炎流行。在非流行地区（美洲、欧洲），3型和4型被认为是人畜共患病原体，可导致散发性急性肝炎。实体器官移植受者中已有戊型肝炎病毒感染的报道；然而，关于肺移植患者的数据有限。
介绍我们科室首例3例肺移植受者感染戊型肝炎病毒的病例。
我们报告了3例移植后患者感染戊型肝炎病毒的病例，这些患者出现了症状且肝酶异常。在肝功能出现异常之前，所有患者均无西班牙境外旅行史。通过家庭聚合酶链反应和酶联免疫吸附测定（IgG/IgM）进行诊断。首例患者未接受治疗，死于进行性肝病，尸检诊断为戊型肝炎病毒感染并发症。另外2例患者在诊断为戊型肝炎病毒感染后接受了利巴韦林治疗。1例患者因贫血需要输注红细胞而停用了利巴韦林。
对于移植后肝酶异常的患者，鉴别诊断时应考虑戊型肝炎病毒感染。早期检测和治疗对预防肝衰竭和降低死亡率具有重要意义。有必要对肺移植患者进行大规模的戊型肝炎病毒血清学前瞻性研究，以了解这种感染在肺移植受者中的流行病学情况。
