Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients

Cordts, S.; Schneble, Lukas; Schnitzler, Paul; Wenzel, Jürgen J.; Vinke, Tobias; Rieger, Susanne; Fichtner, Alexander; Tönshoff, Burkhard; Höcker, Britta

doi:10.1007/s00467-018-3905-7

Cited by 12 publications

(9 citation statements)

References 49 publications

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“…Twenty‐one studies described the effect of reduction of immunosuppressive medication, representing a total of 174 patients 22‐40 . In most patients (67%), the reduced drug was not described.…”

Section: Resultsmentioning

confidence: 99%

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Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Gorris

Lecq

Erpecum

et al. 2020

Journal of Viral Hepatitis

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Hepatitis E virus infection can cause chronic hepatitis in immunocompromised patients with significant chance of progressive fibrosis and possibly cirrhosis. The aim of this systematic review was to summarize the efficacy and safety of the various treatment options for chronic hepatitis E. We performed a systematic literature search. The primary outcome measure was a sustained virological response (SVR). Secondary end points were rapid virological response (RVR), relapse rates, side effects and adverse events. Forty‐four articles were included with a total of 582 patients. Reduction of immunosuppressive medication induced viral clearance in 55/174 (32%) of the patients. Meta‐analysis of 395 patients showed a pooled SVR rate of 78% (95‐CI 72%–84%) after ribavirin treatment. Twenty‐five per cent of the patients obtained a RVR, whereas a relapse occurred in 18% of the patients. Anaemia during treatment led to dose reduction, use of erythropoietin and/or blood transfusion in 37% of the patients. A second treatment attempt with ribavirin led to a SVR in 39/51 (76%) of the patients. Pegylated interferon‐alpha was administered to 13 patients and SVR was obtained in 85%. Two patients (15%) suffered from acute transplant rejection during treatment with interferon. In conclusion, reduction of immunosuppressive medication and treatment with ribavirin is safe, generally well tolerated and induced viral clearance in 32% and 78% of patients, respectively. Therefore, ribavirin should be considered as first treatment step for chronic hepatitis E. Treatment with pegylated interferon‐alpha increases the risk of transplant rejection and should therefore be administered with great caution.

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Section: Resultsmentioning

confidence: 99%

“…Treatment effect of RBV was described in 34 studies 22,23,25‐27,32,34‐36,38‐62 . The majority of the 395 patients treated with RBV was male, and almost all patients were SOT recipients.…”

Section: Resultsmentioning

confidence: 99%

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Gorris

Lecq

Erpecum

et al. 2020

Journal of Viral Hepatitis

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“…Nevertheless, this result should be taken with caution. First, other studies or case reports showed a failure of viral clearance after immunosuppressive dose reduction [17][18][19][20][21]. Second, the elapsed time between the initiation of immunosuppression reduction and the time of self-resolution could be as high as or more than 1 year [11,14].…”

Section: Discussionmentioning

confidence: 99%

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

et al. 2019

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The hepatitis E virus (HEV) is the major cause of acute hepatitis of viral origin worldwide. Despite its usual course as an asymptomatic self-limited hepatitis, there are highly susceptible populations, such as those with underlying immunosuppression, which could develop chronic hepatitis. In this situation, implementation of therapy is mandatory in the sense to facilitate viral clearance. Currently, there are no specific drugs approved for HEV infection, but ribavirin (RBV), the drug of choice, is used for off-label treatment. Here, we present two cases of chronic HEV infection in transplant patients, reviewing and discussing the therapeutic approach available in the literature. The use of RBV for the treatment of an HEV infection in organ transplant patients seems to be effective. The recommendation of 12 weeks of therapy is adequate in terms of efficacy. Nevertheless, there are important issues that urgently need to be assessed, such as optimal duration of therapy and drug dosage.

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“…One pediatric patient developed HEV-induced liver cirrhosis after hematological stem cell transplantation ( Halac et al, 2012a ). In an isolated cohort study of 90 pediatric renal allograft recipients had 13.3%, (12/90) HEV IgG positivity with 4.4% (4/90) recipients had HEV genotype-3 active replication and further leading to chronicity ( Cordts et al, 2018 ). Thus from the available world literature, it is evident that children less frequently get affected with HEV and seldom develop chronicity.…”

Section: Hev Infection and Chronicity In Pediatric And Young Populatimentioning

confidence: 99%

Viral Hepatitis E and Chronicity: A Growing Public Health Concern

et al. 2020

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Hepatitis E viral infection recently emerges as a global health concern. Over the last decade, the understanding of hepatitis E virus (HEV) had changed with the discovery of new genotypes like genotype-7 and genotype-8 with associated host and mode of infection. Diversification in the mode of hepatitis E infection transmission through blood transfusion, and organ transplants in contrast to classical feco-oral and zoonotic mode is the recent medical concern. The wide spectrum of infection ranging from self-limiting to acute liver failure is now overpowered by HEV genotype-specific chronic infection especially in transplant patients. This concern is further escalated by the extra-hepatic manifestations of HEV targeting the central nervous system (CNS), kidney, heart, and pancreas. However, with the development of advanced efficient cell culture systems and animal models simulating the infection, much clarity toward understanding the pathogenetic mechanism of HEV has been developed. Also this facilitates the development of vaccines research or therapeutics. In this review, we highlight all the novel findings in every aspect of HEV with special emphasis on recently emerging chronic mode of infection with specific diagnosis and treatment regime with an optimistic hope to help virologists and/or liver specialists working in the field of viral hepatitis.

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Prevalence, morbidity, and therapy of hepatitis E virus infection in pediatric renal allograft recipients

Cited by 12 publications

References 49 publications

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

Viral Hepatitis E and Chronicity: A Growing Public Health Concern

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