Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis

Kamar, Nassim; Lhomme, Sébastien; Abravanel, Florence; Marion, Olivier; Péron, Jean‐Marie; Alric, Laurent; Izopet, Jacques

doi:10.3390/v8080222

Cited by 39 publications

(34 citation statements)

References 45 publications

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“…Risk factors for the development of a persistent infection include a shorter time from the transplant to diagnosis, a recent episode of acute rejection and low CD4 and CD8 T cell counts (Kamar et al ., ). The use of the calcineurin inhibitor immunosuppressant tacrolimus, as opposed to ciclosporin A, is another independent risk factor for persistent infection in this cohort (Kamar et al ., 2011b).…”

Section: Clinical Aspectsmentioning

confidence: 97%

Hepatitis E: the current state of play

Ankcorn

Tedder

2017

Transfusion Medicine

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The hepatitis E virus (HEV) is a major cause of acute hepatitis globally. Genotypes 1 and 2 (G1 and G2) are obligate human pathogens transmitted faeco-orally, leading to epidemics in developing countries. In contrast, genotypes 3 and 4 (G3 and G4) have a wider host range, including humans, but are primarily porcine viruses and are transmitted from animals to humans as a food-borne zoonosis when meat from an infected animal is consumed. HEV is increasingly recognised as a problem in developed countries, including countries in Europe. G3 HEV is now the most common cause of acute viral hepatitis in the UK and cases continue to rise. The majority of these infections are acquired within the UK and thought to be from insufficiently cooked meat, predominantly processed pork meat. Previously thought to only cause self-limiting disease, HEV infection can persist in immunosuppressed patients, which may lead to chronic hepatitis and the rapid development of cirrhosis. Of particular interest to the transfusion community has been the possibility of transfusion-transmitted HEV, which has been reported from countries classically considered HEV-endemic but also non-endemic countries in Europe and Japan. This has prompted some countries to introduce screening for HEV in blood donations.

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Section: Clinical Aspectsmentioning

confidence: 97%

Hepatitis E: the current state of play

Ankcorn

Tedder

2017

Transfusion Medicine

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“…Several months after LT, meningitis can be secondary to Mycobacterium tuberculosis . It should be noted that another emerging agent is the hepatitis E virus (HEV) that has been recently reported as the causative agent responsible for several neurological manifestations, including encephalitis . Figure summarizes the timeline of these different complications …”

Section: Neurological Complications Of Ltmentioning

confidence: 99%

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

Weiss

Thabut

2019

Liver Transpl

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Orthotopic liver transplantation (LT) remains the only way to definitively cure patients with the most severe liver diseases.Because the survival rate is now fairly high, important questions about neurological sequelae or quality of life after LT have emerged. Indeed, LT represents a peculiar situation because up to 30% of patients present with neurological symptoms after LT compared with only 4% after cardiac transplant and 0.5% after renal transplant. These postoperative neurological symptoms have long been interpreted as sequelae of hepatic encephalopathy (HE). However, postoperative decompensation of an unknown cerebral condition due to the pathophysiology of cirrhosis or undiagnosed neurodegenerative disorders or aging constitute other possibilities that are underrecognized. Some patients who undergo LT for acute liver failure and patients with cirrhosis without episodes of HE and without any previous cerebral alteration also display post-LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either general anesthesia, the surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment. The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant. In this review, we will discuss the neurological complications associated with LT, the neurocognitive complications after LT, and how to assess the LT-related neurological or neurocognitive complications. Furthermore, we will review the various hypotheses surrounding post-LT neurocognitive impairment and will conclude with recommendations for future directions.

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“…While several case series provided evidence for the value of ribavirin in the treatment of chronic hepatitis E [75,89,90,91], the knowledge on treatment of acute hepatitis E is still limited. In patients suffering from HEV-associated acute liver failure, ribavirin represents a possible (off-label) treatment option [92].…”

Section: Treatment Of Acute Hepatitis E Infectionmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

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Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis

Cited by 39 publications

References 45 publications

Hepatitis E: the current state of play

Hepatitis E: the current state of play

Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury

Acute Hepatitis E: Two Sides of the Same Coin

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