1. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants
- Author
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Jacques Izopet, Pascal Lebray, Marie Essig, Robert N. Santella, Anne Marie Roque-Afonso, Valérie Garrigue, Nada Kanaan, Amelie Cannesson, Nassim Kamar, Elisabeth Cassuto-Viguier, Lionel Rostaing, Elizabeth B. Haagsma, Filomena Conti, Cyril Garrouste, Sven Pischke, Christiane Mousson, Sylvie Radenne, Harry R. Dalton, Jérôme Dumortier, Cecile Chauvet, Eric Thervet, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Fédérale Toulouse Midi-Pyrénées, Service de virologie, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Department of Gastroenterology and Hepatology, University Medical Center Groningen [Groningen] (UMCG), Service de Pédiatrie spécialisée, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School [Hannover] (MHH), Département de néphrologie et transplantation, Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), service d'Hépato-gastro-entérologie, Hospices Civiles de Lyon-Hôpital Edouard Heriault, service de néphrologie et transplantation, Centre Hospitalier Universitaire de Nice (CHU Nice), Service de néphrologie adultes [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'hépatologie [Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), European Centre for Environment and Human Health, Royal Cornwall Hospital-Universities of Exeter and Plymouth, North Central Kidney Institute, Avera Mckennan Hospital-University Health Center, Service de néphrologie, Saint-Luc Hospital, Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'hépatologie, Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Laboratoire de Virologie [Purpan], CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Centre de Physiopathologie Toulouse Purpan (ex IFR 30 et IFR 150), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR30-IFR150-Institut National de la Santé et de la Recherche Médicale ( INSERM ), University Medical Center Groningen, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Hannover Medical School [Hannover] ( MHH ), Hospices Civils de Lyon ( HCL ) -Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon ( HCL ), CHU Nice, CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Service d'Hépato-Gastroentérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Hospices Civils de Lyon ( HCL ) -Hôpital de la Croix-Rousse [CHU - HCL], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse, Marquet, Pierre, Laboratoire Virologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service d'hépatologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Royal Cornwall Hospital-Plymouth University
- Subjects
Male ,MESH : Retrospective Studies ,CYCLOSPORINE-A ,medicine.medical_treatment ,MESH : Aged ,Liver transplantation ,medicine.disease_cause ,Polymerase Chain Reaction ,MESH : Hepatitis E virus ,THERAPY ,Organ transplantation ,MESH : Organ Transplantation ,Liver disease ,0302 clinical medicine ,Hepatitis E virus ,Cyclosporin a ,MESH : Female ,MESH: Incidence ,MESH : Polymerase Chain Reaction ,Hepatitis, Chronic ,MESH: Aged ,0303 health sciences ,MESH: Middle Aged ,Incidence ,Liver Disease ,Gastroenterology ,MESH: Follow-Up Studies ,Middle Aged ,MESH : Adult ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,LIVER-TRANSPLANTATION ,MESH : Incidence ,3. Good health ,Hepatitis E ,Virus ,PREVALENCE ,[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences ,Europe ,MESH: Young Adult ,BLOOD-DONORS ,MESH: RNA, Viral ,RNA, Viral ,030211 gastroenterology & hepatology ,Female ,Adult ,MESH: Hepatitis E virus ,medicine.medical_specialty ,MESH : United States ,MESH : Male ,MESH: Hepatitis, Chronic ,MESH : Europe ,MESH : Young Adult ,FRANCE ,MESH: Organ Transplantation ,03 medical and health sciences ,Young Adult ,medicine ,MESH: United States ,Humans ,MESH : RNA, Viral ,MESH : Hepatitis, Chronic ,MESH : Middle Aged ,KIDNEY-TRANSPLANT ,030304 developmental biology ,Aged ,Retrospective Studies ,Hepatitis ,Transplantation ,MESH: Humans ,Hepatology ,business.industry ,MESH : Humans ,MESH: Hepatitis E ,MESH : Follow-Up Studies ,MESH: Adult ,MESH: Polymerase Chain Reaction ,MESH: Retrospective Studies ,Organ Transplantation ,medicine.disease ,Fibrosis ,Tacrolimus ,United States ,MESH: Male ,Chronic infection ,RECIPIENTS ,[ SDV.SP ] Life Sciences [q-bio]/Pharmaceutical sciences ,MESH : Hepatitis E ,Immunology ,REPLICATION ,PEGYLATED INTERFERON-ALPHA ,MESH: Europe ,business ,MESH: Female ,Follow-Up Studies - Abstract
International audience; 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.
- Published
- 2011