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

Abstract

At present, transient asymptomatic hepatitis E virus (HEV) infection is common among healthy adults in Western Europe, as reported by blood transfusion services. In immune-suppressed patients HEV infection is often without clinical symptoms, but without therapeutic intervention it may become chronic and lead to cirrhosis. This report describes the course of chronic HEV infection after kidney transplantation in 2 children, who cleared the virus after reduction in immunosuppressive therapy. If aminotransferase levels continue to be moderately elevated after transplantation, HEV infection should be excluded.

Hepatitis E Virus in Industrialized Countries: The Silent Threat

“…Chronic hepatitis E is caused by genotype 3 strains [9], although one recently described case has been associated with genotype 4 [132]. According to some authors, the reduction of immunosuppressive therapy (if possible) or treatments with ribavirin or pegylated-interferon plus ribavirin may induce the clearance of the virus [15, 114, 125, 131]. In Spain, one chronic HEV infection was identified in an immunocompetent man as reported by Gonzalez Tallon et al [133].…”

Ribavirin therapy of hepatitis E infection may cause hyporegenerative anemia in pediatric renal transplant patients

“…To our knowledge, only 3 cases of HEV‐infected pediatric kidney transplant patients have been reported . In 2 patients, chronic HEV infection was treated effectively only by reducing immunosuppression .…”

“…2,9 In the present case, we found newly devel- To our knowledge, only 3 cases of HEV-infected pediatric kidney transplant patients have been reported. 3,4 In 2 patients, chronic HEV infection was treated effectively only by reducing immunosuppression. 3 Also, 30% of adult solid organ transplants achieved HEV clearance by reduction of immunosuppression alone, 11 which was insufficient in our patient.…”

“…HEV is also known to induce extrahepatic manifestations, including neurological diseases, kidney injury, and hematological disorders . The reported seroprevalence in the pediatric population aged 2‐4 years is 2% . Among 124 pediatric solid organ transplant recipients in Germany, HEV seroprevalence was 3.2% .…”

“…2 The reported seroprevalence in the pediatric population aged 2-4 years is 2%. 3 Among 124 pediatric solid organ transplant recipients in Germany, HEV seroprevalence was 3.2%. 4 Ribavirin therapy has been successfully used for chronic HEV infection in adults, but its efficacy and safety profile in pediatric transplant patients are not known.…”