Wu Eva, Koch Nadine, Bachmann Friederike, Schulz Marten, Seelow Evelyn, Weber Ulrike, Waiser Johannes, Halleck Fabian, Faber Mirko, Bock Claus-Thomas, Eckardt Kai-Uwe, Budde Klemens, Hofmann Jörg, Nickel Peter, Choi Mira
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Pathogens. 2023 Jun 20;12(6):850. doi: 10.3390/pathogens12060850.
There is a significant risk for ongoing and treatment-resistant courses of hepatitis E virus (HEV) infection in patients after solid organ transplantation. The aim of this study was to identify risk factors for the development of hepatitis E, including the dietary habits of patients. We conducted a retrospective single-center study with 59 adult kidney and combined kidney transplant recipients who were diagnosed with HEV infection between 2013 and 2020. The outcomes of HEV infections were analyzed during a median follow-up of 4.3 years. Patients were compared with a control cohort of 251 transplant patients with elevated liver enzymes but without evidence of an HEV infection. Patients' alimentary exposures during the time before disease onset or diagnosis were assessed. Previous intense immunosuppression, especially treatment with high-dose steroids and rituximab, was a significant risk factor to acquire hepatitis E after solid organ transplantation. Only 11 out of 59 (18.6%) patients reached remission without further ribavirin (RBV) treatment. A total of 48 patients were treated with RBV, of which 19 patients (39.6%) had either viral rebounds after the end of treatment or did not reach viral clearance at all. Higher age (>60 years) and a BMI ≤ 20 kg/m were risk factors for RBV treatment failure. Deterioration in kidney function with a drop in eGFR ( = 0.046) and a rise in proteinuria was more common in patients with persistent hepatitis E viremia. HEV infection was associated with the consumption of undercooked pork or pork products prior to infection. Patients also reported processing raw meat with bare hands at home more frequently than the controls. Overall, we showed that the intensity of immunosuppression, higher age, a low BMI and the consumption of undercooked pork meat correlated with the development of hepatitis E.
实体器官移植患者感染戊型肝炎病毒（HEV）后，存在持续感染和治疗抵抗病程的重大风险。本研究的目的是确定戊型肝炎发生的风险因素，包括患者的饮食习惯。我们进行了一项回顾性单中心研究，纳入了59例在2013年至2020年间被诊断为HEV感染的成年肾移植和肾联合移植受者。在中位随访4.3年期间分析了HEV感染的结局。将患者与251例肝酶升高但无HEV感染证据的移植患者组成的对照队列进行比较。评估了患者在疾病发作或诊断前的饮食暴露情况。既往强化免疫抑制，尤其是大剂量类固醇和利妥昔单抗治疗，是实体器官移植后感染戊型肝炎的重要风险因素。59例患者中只有11例（18.6%）在未接受进一步利巴韦林（RBV）治疗的情况下病情缓解。共有48例患者接受了RBV治疗，其中19例患者（39.6%）在治疗结束后出现病毒反弹或根本未实现病毒清除。年龄较大（>60岁）和体重指数≤20 kg/m²是RBV治疗失败的风险因素。在持续戊型肝炎病毒血症患者中，估算肾小球滤过率下降（=0.046）和蛋白尿增加导致的肾功能恶化更为常见。戊型肝炎感染与感染前食用未煮熟的猪肉或猪肉制品有关。患者还报告在家中比对照组更频繁地徒手处理生肉。总体而言，我们发现免疫抑制强度、较高年龄、低体重指数和食用未煮熟的猪肉与戊型肝炎的发生相关。
