Chronic hepatitis E infection in lung transplant recipients

BACKGROUND: Hepatitis E virus (HEV) genotype 3 has been identified in patients with autochthonous HEV infections in developed countries and is currently being recognized as an emerging zoonotic pathogen. HEV infection may lead to a chronic hepatitis in immune-compromised patients.METHODS: We studied the incidence of REV in adult lung transplant recipients at the Medical University Vienna and the University Medical Center Groningen. These recipients presented with elevated liver test results during the post-transplant follow-up period. The time of infection was investigated using stored specimens, and the REV genotype was determined by sequence analysis of the open reading frame (ORF)1 and ORF2 region.RESULTS: The study included 468 adult lung transplant recipients. Ten patients (2.1%) tested positive for HEV RNA. At the time of REV detection, all patients had elevated liver test results, with median alanine aminotransferase levels of 77 U/liter and showed a mild hepatitis. A chronic REV infection was diagnosed in the 8 lung transplant recipients who survived longer than 6 months after transplantation. Viral genotyping revealed only genotype 3 strains. In 2 of the lung transplant recipients treated with oral ribavirin monotherapy, REV RNA was cleared from the plasma within 2 months with simultaneous normalization of alanine aminotransferase levels.CONCLUSIONS: Chronic REV is an important cause of liver test abnormalities after lung transplantation; therefore, routine screening for HEY RNA is strongly recommended in lung transplant recipients. Oral ribavirin appears to be a safe and effective treatment for chronic REV infection in lung transplant recipients. J Heart Lung Transplant 2013;32:341-346 (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.