Bootcongres

Introduction. Non-travel related Hepatitis E virus (HEV) hepatitis is an under diagnosed emerging infection in developed countries. The screening of healthy blood donors in the Netherlands recently showed an overall seroprevalence of 27%. Due to its asymptomatic course it remains unrecognized in the general population, but can be of great clinical importance in immune-compromised patients such as solid-organ transplant (SOT) recipients. Also, it may be the cause of an acute hepatitis within a normally healthy population. Increasing numbers of reports show that HEV genotype 3 infection can cause chronic hepatitis in SOT recipients. This chronic hepatitis may lead to rapidly progressive cirrhosis, necessitating early therapeutic intervention. Methods. Since the second half of 2007, SOT recipients with unexplained hepatitis were screened for HEV and clinical data were collected. HEV was further characterized by sequencing. Results. In total 20 SOT recipients, presenting with elevated ALTs, tested positive for HEV RNA genotype 3. Of these 5 were lung-, 1 heart-, 6 liver- and 6 kidney-transplant recipients; 2 received multiple SOTs. At the time of HEV detection, most patients showed elevated ALT, ranging from 36-1001U/L (median of 128U/L). A chronic infection could be diagnosed in 13 of these 20 SOT recipients (65%). Two kidney-transplant recipients, were able to resolve the infection within 6 months upon reduction of immunosuppression. So far, 10 SOT recipients were successfully treated. Two liver transplant patients were treated with pegylated interferon alpha-2b. Eight patients, 3 lung-, 2 liver-, 1 heart- and 2 multiple organ transplant recipients were treated with oral ribavirin. Discussion. Early recognition of HEV infection as a cause of post transplant hepatitis is crucial to minimize liver damage and may play a role in clinical decision making in liver transplant recipients whether or not initiating anti-rejection treatment. An increasing awareness of the existence of chronic HEV infection among transplant clinicians and medical microbiologists is needed. Low grade liver function test abnormalities after SOT should trigger suspicion of chronic HEV infection. The favorable outcome upon antiviral treatment in 8 SOT recipients suggests that oral ribavirin might be an effective treatment of chronic HEV infection. However, further studies are needed to investigate the effectiveness and optimal duration of antiviral treatment in different groups of SOT recipients.