Abstract
Hepatotropic viral infections are frequent in allograft recipients and may be caused by a number of different viruses. Of these, the most important infectious agents are hepatitis B virus (HBV) and hepatitis C virus (HCV), which can cause both acute and chronic hepatitis. In addition, Hepatitis E virus (HEV), thought previously to only cause acute hepatitis in the developing world, is emerging as an increasing cause of chronic hepatitis and even cirrhosis in solid organ transplant recipients in industrialized countries(Gerolami, Moal et al. 2008; Kamar, Mansuy et al. 2008; Gerolami, Moal et al. 2009; Haagsma, Niesters et al. 2009). Hepatitis D virus (HDV) additionally plays an important role in both coinfection and superinfection of HBV in solid organ transplant recipients. In addition to the primary viral hepatitis infections, a variety of other systemic viral infections, such as the herpesviruses, cytomegalovirus (CMV), Ebstein Barr Virus (EBV), and varicella zoster virus (VZV) can have toxic effects on the liver in the posttransplant recipient. This chapter will focus primarily on the epidemiology, transmission, clinical presentation and management of the primary hepatitis viruses: HBV, HCV, HDV and HEV, following solid organ transplantation. General concepts in the prevention of post-transplant hepatotropic infections and recent advances and challenges will also be discussed.
Highlights
Hepatotropic viral infections are frequent in allograft recipients and may be caused by a number of different viruses
hepatitis B virus (HBV), hepatitis C virus (HCV) and CMV are the most commonly reported hepatotropic viruses transmitted during solid organ transplant though the incidence of transmission has decreased over the last decade due to improvements in screening and vaccination practices
Biopsy is recommended in the assessment of nonhepatic solid organ transplant (SOT) candidates with chronic HCV to guide antiviral treatment decisions, identify those who may be considered for combined transplant and those who are ineligible for nonhepatic SOT due to advanced liver disease(Doucette, Weinkauf et al 2007)
Summary
Hepatotropic viral infections are frequent in allograft recipients and may be caused by a number of different viruses. The most important infectious agents are hepatitis B virus (HBV) and hepatitis C virus (HCV), which can cause both acute and chronic hepatitis. Hepatitis E virus (HEV), thought previously to only cause acute hepatitis in the developing world, is emerging as an increasing cause of chronic hepatitis and even cirrhosis in solid organ transplant recipients in industrialized countries(Gerolami, Moal et al 2008; Kamar, Mansuy et al 2008; Gerolami, Moal et al 2009; Haagsma, Niesters et al 2009). Hepatitis D virus (HDV) plays an important role in both coinfection and superinfection of HBV in solid organ transplant recipients. This chapter will focus primarily on the epidemiology, transmission, clinical presentation and management of the primary hepatitis viruses: HBV, HCV, HDV and HEV, following solid organ transplantation. General concepts in the prevention of post-transplant hepatotropic infections and recent advances and challenges will be discussed
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