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Infection with hepatitis E virus in kidney transplant recipients in southeastern France

Authors

  • Valérie Moal,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
    2. Aix-Marseille Univ., Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Marseille, France
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  • Tristan Legris,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
    2. Aix-Marseille University, Marseille, France
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  • Stéphane Burtey,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
    2. Aix-Marseille University, Marseille, France
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  • Sophie Morange,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre d'Investigation Clinique, Marseille, France
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  • Raj Purgus,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
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  • Bertrand Dussol,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
    2. Aix-Marseille University, Marseille, France
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  • Stéphane Garcia,

    1. Aix-Marseille University, Marseille, France
    2. Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Laboratoire d'Anatomie Pathologique, Marseille, France
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  • Anne Motte,

    1. Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, IHU Méditerranée Infection, Centre Hospitalo-Universitaire Timone, Marseille, AP-HM, France
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  • René Gérolami,

    1. Aix-Marseille University, Marseille, France
    2. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Service d'Hépato-Gastro-Entérologie, Marseille, France
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  • Yvon Berland,

    1. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, Marseille, France
    2. Aix-Marseille University, Marseille, France
    3. Assistance Publique-Hôpitaux de Marseille, Hôpital Conception, Centre d'Investigation Clinique, Marseille, France
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  • Philippe Colson

    Corresponding author
    1. Aix-Marseille Univ., Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 7278 IRD 198 INSERM U1095, Facultés de Médecine et de Pharmacie, Marseille, France
    2. Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, IHU Méditerranée Infection, Centre Hospitalo-Universitaire Timone, Marseille, AP-HM, France
    • Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France.
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  • Conflicts of interest: none.

Abstract

Hepatitis E virus (HEV) is an emerging cause of acute hepatitis in Europe, particularly in southern France, and HEV is a new causative agent of chronic hepatitis and cirrhosis in immunocompromised patients. However, the data regarding HEV infection after kidney transplantation are still scarce with respect to the clinical issues that have been raised, and no study has specifically focused on kidney transplant recipients. This study described the clinical features and outcomes of HEV infections in a cohort of kidney transplant recipients living in southeastern France. The epidemiological, clinical, and virological characteristics of HEV infections diagnosed by PCR over a 53-month period were retrospectively analyzed in a cohort of 1,350 kidney transplant recipients monitored at the Marseille University Hospital. Sixteen HEV infections were diagnosed, all of which were autochthonous and involved genotype 3 viruses (HEV-3). Chronic infections occurred in 80% of these patients and resolved in half of the cases after a median time of 39 months. The rate of HEV clearance was 54% after a decrease in the dose of immunosuppressants. One patient developed liver cirrhosis 14 months after infection and experienced acute rejection after a decrease in the dose of immunosuppressants. Autochthonous HEV-3 infections in kidney transplant recipients progress to chronicity in most cases and might be complicated by early liver cirrhosis. Chronic HEV infection can resolve following the reduction of immunosuppressive therapy, but ribavirin may be required if reduction of the immunosuppressant dose is not associated with HEV clearance or is inappropriate for the patient management. J. Med. Virol. 85:462–471, 2013. © 2012 Wiley Periodicals, Inc.

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