Hepatitis E Virus after Heart Transplantation, Single Center Experience

Abstract

Purpose Hepatitis E virus (HEV) infection can cause chronic hepatitis and can lead to liver cirrhosis and liver failure in patients after solid organ transplantation. However, there is no approved therapy of HEV infection so far. Methods We present three patients after heart transplantation (HTx) with confirmed HEV virus replication at various stages of the disease who were successfully treated with ribavirin monotherapy. Results 62-year old man after HTx in 2/2012 for advanced heart failure due to ischemic cardiomyopathy had had long-term elevated aminotransferases due to right ventricle failure with ascites. During the first year after HTx, ALT and GMT increased significantly despite circulatory compensation. Ascites reappeared and portal hypertension was confirmed with hepatic venous pressure gradient of 18 mmHg and oesophageal varices. Necroinflammatory changes in liver biopsy samples were found. HEV infection was confirmed by HEV RNA positivity in the blood. Due to the long-term course and the findings described, HEV infection was classified as chronic. After six months of therapy with ribavirin, ALT levels normalized and small oesophageal varices regressed. HEV RNA remained negative 6 month after the end of therapy, the patient achieved sustained virological response (SVR). The patient is still alive in good clinical condition. In the second patient, 69-year old man, laparoscopic cholecystectomy (CHCE) for cholecystitis was performed two years after HTx. Abdominal discomfort persisted for three months after CHCE together with ALT elevation. HEV infection was confirmed by HEV RNA positivity. The patient achieved SVR as well with 4 months of ribavirin therapy. In the third patient, 44-year old man, who presented with slightly elevated liver enzymes levels, acute HEV infection was diagnosed 3 years after HTx. After 4 months of ribavirin therapy, ALT became normal and the patient achieved SVR. Conclusion In solid organ transplant recipient, HEV infection may take a chronic course with rapid progression of liver disease despite minimal clinical symptoms. It is necessary to think of the diagnosis because ribavirin therapy is higly effective and may prevent progression of liver fibrosis.