Eliminating viral hepatitis in children after liver transplants: How to reach the goal by 2030

Abstract

Viral hepatitis infections are a great burden in children who have received liver transplant. Hepatotropic viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long term. Immunological reactions due to viral hepatitis infections are associated with or can mimic graft rejection, rendering the condition difficult to manage. Prevention strategies using vaccinations are agreeable to patients, safe, cost-effective and practical. Hence, strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver transplant. Although a vaccine has been developed to prevent hepatitis C and E viruses, its use is not licensed worldwide. Consequently, eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral therapy. Good hygiene and sanitation are also important to prevent hepatitis A and E infections. Donor blood products and liver grafts should be screened for hepatitis B, C and E in children who are undergoing liver transplantation. Future research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and E. Moreover, novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.

Prevalence and the impact of hepatitis E infection in pediatric liver transplanted recipients with hepatitis in Thailand

“…Moreover, investigations to exclude HEV infection in immunocompromised children with transaminitis are not routinely performed. To the best of our knowledge, only seven studies about the prevalence of HEV infection in children with LT have been published, and only five cases of chronic hepatitis E infection have been evidenced 12,29 . In one of them, (20%) HEV could be cleared after decreasing immunosuppressant dosages, 13 which is in line with our findings in two of the cases in the present study; however, ribavirin (10–15 mg/kg/day) was initiated for 3–10 months in four (80%) patients 12,15,17 .…”

“…To the best of our knowledge, only seven studies about the prevalence of HEV infection in children with LT have been published, and only five cases of chronic hepatitis E infection have been evidenced. 12,29 In one of them, (20%)…”

Hepatitis B virus infection among the tribal and particularly vulnerable tribal population from an eastern state of India: Findings from the serosurvey in seven tribal dominated districts, 2021–2022

“…In our study, 1.8% of the participants in the age group of 6–9 years (born after the introduction of HB vaccine) were HBsAg positive, which might be breakthrough infections. Regular monitoring of humoral immunity for HBV and revaccination programs in cases with immunity loss are necessary ( Sintusek et al, 2022 ). In our study, 42.9% of HBsAg positive individuals showed the presence of HBV DNA and the high viral load ranged 0.10 × 10 2 –6.84×10 8 IU/mL which indicates a high potential to transmit the virus and corroborates an earlier report ( Dwibedi et al, 2014 ).…”