SUN-123 WHEN SHOULD WE TREAT HEPATITIS E IN RENAL TRANSPLANT PATIENTS?

Abstract

Whereas Hepatitis E (HepE) is a self-limiting illness in immunocompetent individuals, chronicity is increasingly reported among immunocompromised individuals. In the absence of established therapy for HepE, current approach is initial monitoring with treatment for viral persistence. We hypothesized that spontaneous resolution is infrequent among immunocompromised renal transplant recipients(RTX), warranting early treatment. This single-centre, retrospective study evaluated clinical and laboratory characteristics and outcomes for RTX with HepE at our Centre. 10 RTX were diagnosed with HepE from 2013-2018 yielding a yearly incidence of up to 1,082/100,000 population among RTX, in comparison to 0.92/100,000 in the general population.Among study patients (90% Male, Median age 55 years, 80% Chinese, 20% Indian), 2 reported intake of Chinese sausages or raw oysters and 1 Indian male had exposure to plasma products. Diagnosis of HepE was made on viral load detection among 9 RTX and by serology in 1 RTX at an interval of 111-8,770 days. At diagnosis, median AST was 80IU/mL, ALT 133IU/mL and ALP 102.5IU/mL and viral load was 1,140,000IU/ml.Immunosuppression decrease (IS_Dec) alone was successful in achieving viral clearance in 1 RTX with a low viral load of 4,380 copies; another RTX did not achieve clearance despite trial of IS_Dec over 188 days. The remainder could not undergo IS_Dec for clinical reasons and had Ribavirin initiated within 50 days of diagnosis. Of 9 treated with Ribavirin, 4(44.4%) developed anaemia, the majority requiring erythropoietin.7 out of 8 (87.5%) achieved viral clearance within 105 days after initiation, 2(22.2%) had relapse /reinfection requiring re-treatment while 1 had treatment failure due to treatment-limiting side effects. HepE has a high incidence among RTX, presenting with mild transaminitis and responding to Ribavirin in the majority. As viral clearance with IS_Dec is not effective or feasible in the majority, our results advocate for early treatment for HepE among RTX.