Chronic Hepatitis E in Heart Transplant Recipients

• Published in: American journal of transplantation Vol. 12; no. 11; pp. 3128 - 3133
• Main Authors: Pischke, S., Stiefel, P., Franz, B., Bremer, B., Suneetha, P. V., Heim, A., Ganzenmueller, T., Schlue, J., Horn‐Wichmann, R., Raupach, R., Darnedde, M., Scheibner, Y., Taubert, R., Haverich, A., Manns, M. P., Wedemeyer, H., Bara, C. L.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2012; Wiley; Elsevier Limited
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; Case-Control Studies; Chronic Disease; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Germany - epidemiology; Heart; heart transplantation; Heart Transplantation - immunology; Heart Transplantation - statistics & numerical data; Hepatitis; Hepatitis Antibodies - analysis; hepatitis E; Hepatitis E - epidemiology; Hepatitis E - immunology; Hepatitis E - pathology; Hepatitis E virus; Hepatitis E virus - immunology; Hepatitis E virus - isolation & purification; Hepeviridae; HEV; Human viral diseases; Humans; Immunocompromised Host - immunology; Immunohistochemistry; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction; Prevalence; Prospective Studies; Risk Assessment; RNA, Viral - analysis; Sex Distribution; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Transplants & implants; Viral diseases; Viral hepatitis; Young Adult; Germany; Heart; heart transplantation; Hepatic disease; Homotransplantation; Infection; Chronic; Treatment; Surgery; Viral disease; HEV; hepatitis E; Graft; Digestive diseases; Cardiac transplantation; Circulatory system; Viral hepatitis E
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04200.x

Chronic courses of hepatitis E virus (HEV) infections have been described in immunosuppressed patients. We aimed to study the role of HEV infections in heart transplant recipients (HTR). 274 HTR were prospectively screened for HEV infection using an anti‐HEV‐IgG ELISA and HEV‐PCR. In addition, 137 patients undergoing cardiac surgery (non‐HTR) and 537 healthy subjects were studied cross‐sectionally. The anti‐HEV‐IgG seroprevalence was 11% in HTR, 7% in non‐HTR and 2% in healthy controls (HTR vs. healthy controls p<0.0001; non‐HTR vs. healthy controls p<0.01). Anti‐HEV tested positive in 4.0% in control cohorts of other immunocompromised patients (n = 474). Four HTR (1.5%) were chronically infected with HEV as shown by HEV‐PCR and all four patients had liver transaminases of >200 IU/L and histological or clinical evidence of advanced liver disease. In three patients ribavirin treatment was successful with a sustained biochemical and virological response while treatment failed in one cirrhotic patient after ribavirin dose reduction. Heart transplant recipients and patients undergoing cardiac surgery have an increased risk for HEV infections. Chronic hepatitis E may explain elevated liver enzymes in heart transplant recipients. Treatment of HEV infection with ribavirin is effective but the optimal dose and duration of ribavirin therapy remains to be determined. Heart transplant recipients have an increased risk for infections with the hepatitis E virus, leading to progressive chronic hepatitis in some patients, which can be treated with ribavirin.