Epidemiology and treatment of hepatitis E in the liver transplantation setting: A literature review

Abstract

Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing countries, but it can also take a chronic course especially in immunocompromised patients. Its epidemiology after liver transplantation (LT) is hard to assess and treatment options are still explored. Between 2009 and 2020, literature reporting HEV prevalence and treatment in LT recipients was searched and a synthesis was attempted. Sixteen studies reported HEV prevalence in consecutive LT patients: HEV RNA positivity ranged between 0%–1.4% and 0%–7.7% for Western and Eastern cohorts, respectively. In studies published between 2009–2014 and 2015–2020, HEV RNA positivity ranged between 0.35%–1.3% (all European) and 0%–7.7% (European: 0%–1.4%), respectively. Five studies evaluated HEV prevalence in LT recipients with abnormal liver enzymes: HEV RNA positivity was 2.9% in studies published between 2009 and 2014 and from 3.5% to 20% in studies published between 2015 and 2020. Twenty‐seven studies reported HEV treatment in LT recipients: sustained virologic response was achieved in 15% by immunosuppression reduction alone and in 83% of cases by ribavirin regiments. Chronic HEV infection is affecting LT recipients, mostly those with abnormal liver enzymes and in Eastern countries. HEV diagnoses should be based on PCR techniques. Successful treatment can be achieved with ribavirin in most cases.

A Case of Hepatitis E in The Liver Transplant Recipient

“…In patients with HEV recurrence, a longer course was utilized (Kamar et al, 2010). Studies have also shown that treatment of HEV with Ribavirin with or without immunosuppression reduction was more effective in achieving SVR when compared to immunosuppression alone, > 80% vs 15% (Markakis et al, 2022). Notable side effects include dosedependent anemia and impaired kidney function.…”

Hepatitis E Virus (HEV) Infection in Hemodialysis Patients: A Multicenter Epidemiological Cohort Study in North-Eastern Greece

“…Additionally, in a study from Poland, raising and having contact with farm animals was associated with HEV infection among hunters [ 21 ]. Thus, several studies have proven that people working in agriculture or who are exposed to specific animals (deposits of HEV), such as pigs, wild boars and deers, have a greater risk of HEV infection [ 22 , 23 ], underlining the zoonotic risk of the infection in most European studies [ 24 , 25 , 26 ].…”

The Diagnosis, Pathophysiology, and Treatment of Chronic Hepatitis E Virus Infection—A Condition Affecting Immunocompromised Patients

“…Ribavirin (RBV) has been reported to show excellent efficacy and safety in treating CHE. In a multicenter retrospective study including 59 solid organ transplant recipients treated with RBV, a sustained virologic response (SVR)—defined as an undetectable serum HEV RNA level for at least 6 months after the cessation of medication—was achieved in 78% of initial treatment cases, 85% of overall cases (including retreatment cases [ 77 ]), and 83% of liver transplant recipients [ 78 ]. The exact mechanism of RBV on HEV clearance remains unclear.…”