Get access

Course and treatment of chronic hepatitis E virus infection in lung transplant recipients

Authors

  • S. Pischke,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. IFB-TX, Hannover, Germany
    Search for more papers by this author
    • These authors contributed equally and are both considered first authors.
  • M. Greer,

    1. IFB-TX, Hannover, Germany
    2. Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
    • These authors contributed equally and are both considered first authors.
  • S. Hardtke,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • B. Bremer,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • A. Gisa,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • P. Lehmann,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • A. Haverich,

    1. Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • T. Welte,

    1. Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
  • M.P. Manns,

    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. IFB-TX, Hannover, Germany
    Search for more papers by this author
  • H. Wedemeyer,

    Corresponding author
    1. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. IFB-TX, Hannover, Germany
    • Correspondence to:

      Prof Dr Heiner Wedemeyer, Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, Hannover 30625, Germany

      Tel: +49 511 532 6814

      Fax: +49 511 532 8662

      E-mail: wedemeyer.heiner@mh-hannover.de

    Search for more papers by this author
    • These authors contributed equally and are both considered senior authors.
  • J. Gottlieb,

    1. IFB-TX, Hannover, Germany
    2. Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
    Search for more papers by this author
    • These authors contributed equally and are both considered senior authors.
  • the Hepatitis E study group


Abstract

Objective

Persistent hepatitis E virus (HEV) infections have been described in various transplant cohorts. However, the frequency and the course of HEV infection in lung transplant recipients (Lu-Tr) are not well defined.

Methods

We retrospectively analyzed serum from 95 Lu-Tr for HEV RNA and anti-HEV immunoglobulin-G (IgG) (with the MP assay). Anti-HEV seroprevalence was compared to that of 537 healthy individuals. Prospective HEV screening was subsequently initiated in Lu-Tr.

Results

Elevated liver enzymes were observed in 44/95 (46.3%) patients. Anti-HEV IgG was present in 5/95 patients (5.3%), revealing a slightly higher prevalence compared to controls (2%, 11/537; P = 0.07). Chronic HEV infection with detectable viral replication was confirmed by polymerase chain reaction in 3 (3.2%) patients, all of whom demonstrated clinical and biochemical features of active liver disease (maximum alanine aminotransferase [ALTmax] 89, 215, and 270 IU/L, respectively). One patient had died from multi-organ failure in combination with liver cirrhosis before HEV diagnosis. Two additional patients with chronic hepatitis E were identified during prospective screening (ALTmax 359 and 318 IU/L). All patients still alive commenced ribavirin therapy for 5 months, with dose adjustment (400–600 mg/day) according to renal function and hemoglobin level. Sustained resolution of HEV infection occurred in 2 patients. One patient is still under treatment, and the fourth died from graft failure considered unrelated to ribavirin therapy.

Conclusion

Chronic hepatitis E should be considered in the differential diagnosis of elevated liver enzymes, which are commonly seen in Lu-Tr. We observed 1 case of end-stage liver cirrhosis and death in an HEV-infected subject, who was not treated with ribavirin. Given this potentially devastating consequence, ribavirin therapy of persistent HEV infection appears to be acceptably safe and effective in Lu-Tr. However, larger prospective studies are warranted.

Get access to the full text of this article

Ancillary