Chronic hepatitis E infection in children with liver transplantation

Abstract

The diagnosis of HEV infection is technically challenging and should be made simultaneously with RT-PCR methods, viral load quantification and serological markers. In immunosuppressed children who develop chronic hepatitis, the prevalence of HEV is high and could explain the chronic liver inflammation potentially leading to cirrhosis. Re-infection by different HEV strains from zoonotic transmission can result in progressive liver disease in immunocompromised children.

Chronic Hepatitis E Virus Infection and Treatment

“…9,[11][12][13][14]16,17 Seroprevalence and Incidence of HEV Infection Among Pediatric Patients with a SOT A few cases of acute and chronic HEV have been reported in liver-and kidney-transplant patients from Quebec, France, and Germany. [18][19][20][21] In these patients, HEV seroprevalence, assessed by different serological assays, ranged from 2.3 to 86%. 18,20 HEV-related cirrhosis in a child who had undergone a bone-marrow transplant was reported.…”

“…[18][19][20][21] In these patients, HEV seroprevalence, assessed by different serological assays, ranged from 2.3 to 86%. 18,20 HEV-related cirrhosis in a child who had undergone a bone-marrow transplant was reported. 25 A single case of HEV reactivation has been also reported in a patient with acute lymphoblastic leukemia after an allogeneic stem-cell transplant.…”

“…11,12,14,18,[36][37][38][39][40][41][42][43][44][45][46][47][48] A large multicenter retrospective study, which included 85 adult patients with a SOT (kidney-, liver-, kidney-pancreas-, islet-, heart-, and lung-transplants) showed that 34.1% had spontaneous clearance of HEV within the first 6 months after HEV was diagnosed and no HEV reactivation later on, whereas 65.9% developed chronic hepatitis. 49 Interestingly, in contrast to non-immunosuppressed patients who usually present to hospital with jaundice, 50 when HEV was diagnosed, only 32% of patients were symptomatic.…”

“…49 Several other cases of HEVinduced cirrhosis have been reported. 12,18,33,[36][37][38]40,49 In one study, liver fibrosis rapidly evolved in transplant patients who were chronically infected by HEV, and this led to decompensated cirrhosis and death. 40 Slow HEV quasispecies diversification during the first year after infection has been associated with rapidly developing liver fibrosis.…”

Chronic Hepatitis E Resolved by Reduced Immunosuppression in Pediatric Kidney Transplant Patients

“…1 When unnoticed or left untreated, chronic HEV infection may rapidly lead to cirrhosis. 6,[12][13][14][15] Fortunately, chronic HEV infection can be successfully treated, for example by modest decreases in immunosuppression. Of course, this approach may lead to rejection of the organ transplant.…”