Solignac Justine, Boschi Celine, Pernin Vincent, Fouilloux Virginie, Motte Anne, Aherfi Sarah, Fabre-Aubrespy Maxime, Legris Tristan, Brunet Philippe, Colson Philippe, Moal Valérie
Centre de Néphrologie Et Transplantation Rénale, Aix Marseille Université, Publique Hôpitaux de Marseille, Hôpital Conception, 147 Boulevard Baille, 13005, Marseille, France.
IHU Méditerranée Infection, Publique Hôpitaux de Marseille, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
Virol J. 2024 Jun 12;21(1):136. doi: 10.1186/s12985-024-02401-2.
Hepatitis E is a potentially serious infection in organ recipients, with an estimated two-thirds of cases becoming chronic, and with a subsequent risk of cirrhosis and death. In Europe, transmission occurs most often through the consumption of raw or undercooked pork, more rarely through blood transfusion, but also after solid organ transplantation. Here we describe a case of Hepatitis E virus (HEV) infection transmitted following kidney transplantation and review the literature describing cases of HEV infection transmitted by solid organ transplantation.
Three weeks after kidney transplantation, the patient presented with an isolated minimal increase in GGT and hepatic cytolysis 6 months later, leading to the diagnosis of genotype 3c hepatitis E, with a plasma viral load of 6.5 logIU/mL. In retrospect, HEV RNA was detected in the patient's serum from the onset of hepatitis, and in the donor's serum on the day of donation, with 100% identity between the viral sequences, confirming donor-derived HEV infection. Hepatitis E had a chronic course, was treated by ribavirin, and relapsed 10 months after the end of treatment.
Seven cases of transmission of HEV by solid organ transplantation have been described since 2012 without systematic screening for donors, all diagnosed at the chronic infection stage; two patients died. HEV organ donor transmission may be underestimated and there is insufficient focus on immunocompromised patients in whom mild liver function test impairment is potentially related to hepatitis E. However, since HEV infection is potentially severe in these patients, and as evidence accumulates, we believe that systematic screening of organ donors should be implemented for deceased and living donors regardless of liver function abnormalities, as is already the case in the UK and Spain. In January 2024, the French regulatory agency of transplantation has implemented mandatory screening of organ donors for HEV RNA.
戊型肝炎在器官移植受者中是一种潜在的严重感染，估计三分之二的病例会发展为慢性感染，随后有肝硬化和死亡风险。在欧洲，传播最常通过食用生的或未煮熟的猪肉发生，较少通过输血传播，但也可在实体器官移植后发生。在此，我们描述一例肾移植后传播的戊型肝炎病毒（HEV）感染病例，并回顾描述实体器官移植传播HEV感染病例的文献。
肾移植三周后，患者出现孤立的谷氨酰转肽酶轻度升高，6个月后出现肝细胞溶解，导致诊断为3c型戊型肝炎，血浆病毒载量为6.5 logIU/mL。回顾发现，从肝炎发作起患者血清中就检测到HEV RNA，捐献当天供者血清中也检测到HEV RNA，病毒序列间有100%的同一性，证实为供者源性HEV感染。戊型肝炎呈慢性病程，用利巴韦林治疗，治疗结束10个月后复发。
自2012年以来，已描述了7例实体器官移植传播HEV的病例，均未对供者进行系统筛查，所有病例均在慢性感染阶段确诊；2例患者死亡。HEV器官供者传播可能被低估，对免疫功能低下患者的关注不足，这些患者肝功能检查轻度受损可能与戊型肝炎有关。然而，由于HEV感染在这些患者中可能很严重，且随着证据的积累，我们认为应该对已故和在世的器官供者进行系统筛查，无论其肝功能是否异常，英国和西班牙已经这样做了。2024年1月，法国移植监管机构已实施对器官供者进行HEV RNA强制筛查。
