School of Medicine, Wayne State University, Detroit, Michigan.
School of Medicine, Wayne State University, Detroit, Michigan.
Transplant Proc. 2022 Sep;54(7):1737-1741. doi: 10.1016/j.transproceed.2022.04.025. Epub 2022 Jul 28.
Transplant-related hepatitis E virus (HEV) infection is a rarely recognized phenomenon with significant clinical importance given its potential to result in chronic hepatitis posttransplant.
We retrospectively evaluated HEV diagnosis and treatment after liver, kidney, and heart transplant in a single center. We identified patients diagnosed with HEV by serologic testing and evaluated their treatment regimens.
Fifteen transplant recipients (12 liver, 2 kidney, and 1 heart) presented with elevated liver enzymes and were positive for HEV IgM antibody. Liver enzymes normalized in 4 patients after being treated with ribavirin. One of the 4 patients had 2 recurrences with positive HEV RNA results following ribavirin treatment but recovered after 12 months of ribavirin therapy. After treatment with reduction in immunosuppression without antiviral treatment, 6 of 8 patients' liver enzymes normalized. One of these patients died of acute pancreatitis 2 months after testing positive for HEV IgM antibody.
The potential for complications related to active HEV infections in transplant recipients necessitates prompt diagnosis and treatment to prevent irreversible damage. Diagnosis with HEV reverse transcriptase-polymerase chain reaction should follow a positive HEV IgM antibody test. This manuscript provides evidence that ribavirin antiviral therapy and reducing immunosuppression are effective treatments for HEV infections in liver, kidney, and heart transplant recipients, which has not been sufficiently investigated in the population of the United States. Larger multicenter studies are needed to confirm the risks and benefits of using ribavirin antiviral therapy as first-line therapy of HEV posttransplant.
移植相关戊型肝炎病毒（HEV）感染是一种罕见的现象，具有重要的临床意义，因为它有可能导致移植后慢性肝炎。
我们在一个中心回顾性评估了肝、肾和心脏移植后 HEV 的诊断和治疗。我们通过血清学检测确定了诊断为 HEV 的患者，并评估了他们的治疗方案。
15 名移植受者（12 例肝移植、2 例肾移植和 1 例心脏移植）出现肝酶升高，且 HEV IgM 抗体阳性。4 例患者用利巴韦林治疗后肝功能恢复正常。其中 1 例患者在接受利巴韦林治疗后有 2 次复发，且 HEV RNA 结果阳性，但在接受利巴韦林治疗 12 个月后恢复。在减少免疫抑制而不进行抗病毒治疗后，8 例患者中有 6 例肝功能恢复正常。其中 1 例患者在 HEV IgM 抗体检测阳性后 2 个月死于急性胰腺炎。
活跃的 HEV 感染相关并发症在移植受者中很常见，因此需要及时诊断和治疗，以防止不可逆转的损害。如果 HEV IgM 抗体检测阳性，应进行 HEV 逆转录酶-聚合酶链反应检测。本研究报告提供的证据表明，利巴韦林抗病毒治疗和减少免疫抑制是肝、肾和心脏移植受者 HEV 感染的有效治疗方法，在美国人群中尚未得到充分研究。需要更大规模的多中心研究来确认使用利巴韦林抗病毒治疗作为移植后 HEV 的一线治疗的风险和益处。
