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Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants.

Abstract：

BACKGROUND & AIMS:Hepatitis E virus (HEV) infection can cause chronic hepatitis in recipients of solid organ transplants. However, the factors that contribute to chronic infection and the outcomes of these patients are incompletely understood. We performed a retrospective analysis of data from 17 centers from Europe and the United States that described the progression, outcomes, and factors associated with development of chronic HEV infection in recipients of transplanted solid organs. METHODS:We studied data from 85 recipients of solid organ transplants who were infected with HEV. Chronic HEV infection was defined by the persistent increases in levels of liver enzymes and polymerase chain reaction evidence of HEV in the serum and/or stool for at least 6 months. RESULTS:Fifty-six patients (65.9%) developed chronic hepatitis. Univariate analysis associated liver transplant, shorter times since transplant, lower levels of liver enzymes and serum creatinine, lower platelet counts, and tacrolimus-based immunosuppressive therapy (rather than cyclosporin A) with chronic hepatitis. On multivariate analysis, the independent predictive factors associated with chronic HEV infection were the use of tacrolimus rather than cyclosporin A (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.49-1.97; P = .004) and a low platelet count at the time of diagnosis with HEV infection (OR, 1.02; 95% CI, 1.001-1.1; P = .04). Of patients with chronic hepatitis, 18 (32.1%) achieved viral clearance after the dose of immunosuppressive therapy was reduced. No HEV reactivation was observed after HEV clearance. CONCLUSIONS:HEV infection causes chronic hepatitis in more than 60% of recipients of solid organ transplants. Tacrolimus therapy is the main predictive factor for chronic hepatitis. Dose reductions of immunosuppressive therapy resulted in viral clearance in more than 30% of patients.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Kamar N,Garrouste C,Haagsma EB,Garrigue V,Pischke S,Chauvet C,Dumortier J,Cannesson A,Cassuto-Viguier E,Thervet E,Conti F,Lebray P,Dalton HR,Santella R,Kanaan N,Essig M,Mousson C,Radenne S,Roque-Afonso AM,Izopet J,

doi

10.1053/j.gastro.2011.02.050

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

1481-9

issue

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(11)00261-7

journal_volume

140

pub_type

杂志文章,多中心研究

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Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants.