Pegylated interferon may be considered in chronic viral hepatitis E resistant to ribavirin in kidney transplant recipients

I Ollivier-Hourmand,T T N Nguyen,T Dao,L Lebedel,M Allaire,M Allaire,M Allaire,M Allaire,M Allaire,A Lecouf,C Lier

doi:10.1186/s12879-020-05212-2

Abstract

BackgroundHepatitis E virus (HEV) may be resistant to immunosuppression reduction and ribavirin treatment in kidney transplant recipients because of mutant strains and severe side effects of ribavirin which conduct to dose reduction. Sofosbuvir efficacy is controversial. Peg-interferon 2 alpha (PEG-IFN) is currently contraindicated due to a high risk of acute humoral and cellular rejection. The present study assessed, for the first time, the effect of PEG-IFN in a kidney transplant recipient infected with HEV.Case presentationThe patient had chronic active HEV that was resistant to immunosuppression reduction and optimal ribavirin treatment. He developed significant liver fibrosis. PEG-IFN was administered for 10 months, and it was well tolerated and did not induce rejection. A sustained virological response was obtained.ConclusionsWe conclude that prolonged treatment with PEG-IFN in kidney transplant recipients infected with HEV could be considered as a salvage option.

Highlights

Hepatitis E virus (HEV) may be resistant to immunosuppression reduction and ribavirin treatment in kidney transplant recipients because of mutant strains and severe side effects of ribavirin which conduct to dose reduction
PEG IFN 2 alpha was used in liver transplant (LTR) patients infected by hepatitis C (HCV) with a 50% sustained virological response (SVR), but it was contraindicated in other solid organ transplant (SOT) due to a higher expected risk of acute humoral and cellular rejection [4, 13,14,15,16]
Peg-interferon alpha (PEG-IFN) was successfully prescribed in 5 LTR patients infected by HEV [3] but not in other SOTs

Summary

Introduction

Hepatitis E virus (HEV) may be resistant to immunosuppression reduction and ribavirin treatment in kidney transplant recipients because of mutant strains and severe side effects of ribavirin which conduct to dose reduction. Immunosuppressed patients may fail to clear HEV infection, which is responsible for chronic hepatitis [1,2,3]. When chronic HEV persists despite immunosuppression reduction, the first line treatment is at least a 3-month course of ribavirin (RBV).

Results

Conclusion