Clinical

Hepatitis E virus can cause chronic disease in transplant recipients

Last Updated: 2008-02-21 14:56:00 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Although commonly considered a pathogen capable of causing only acute disease, hepatitis E virus (HEV) can cause chronic hepatitis in organ-transplant recipients, French researchers report.

HEV-related acute hepatitis is endemic in developing countries, Dr. Nassim Kamar and colleagues note, and the disease is becoming more common in industrialized countries. Although studies have suggested that seropositivity with anti-HEV antibodies is not rare in transplant recipients, just three cases of HEV-related acute hepatitis in transplant recipients have been reported, and two cases of persistent HEV infection have been documented.

In a brief report in The New England Journal of Medicine on February 21, Dr. Kamar, from Centre Hospitalier Universitaire Rangueil in Toulouse, and colleagues from several centers describe the course of HEV infection that arose in 3 liver transplant recipients, 9 kidney recipients, and 2 recipients of combined kidney-pancreas transplants. None of the patients had chronic infection with hepatitis B, C or D virus.

Eight of the patients developed chronic hepatitis, based on elevated aminotransferase levels, histologic features, and HEV RNA in serum or stool for an average of 15 months after the acute phase.

None of the patients received antiviral therapy, and no changes were made in their immunosuppression regimens after HEV was diagnosed.

Correlates of progression to chronic disease included a shorter time from transplantation to diagnosis and lower total counts of lymphocytes and of CD2+, CD3+, and CD4+ T cells, the authors note.

"Our data suggest that HEV should be considered an etiologic agent of hepatitis in organ-transplant recipients. We have demonstrated that HEV infection can evolve to chronic hepatitis, at least in organ-transplant recipients," the researchers write.

N Engl J Med 2008;358:811-817.