HEPATITIS E infection affected 3.5% of transplant patients, with a high chronicity risk. Treatment and screening central to patient management.
Hepatitis E virus (HEV) infection affects a small but clinically significant proportion of solid organ transplant recipients, with recent long-term data highlighting risks of chronic hepatitis, treatment outcomes, and extrahepatic manifestations.
A single-centre retrospective analysis of 6,452 transplant recipients followed from 2001 to 2024 found that 228 patients (3.53%) were diagnosed with HEV infection, with liver transplant recipients showing a higher incidence than other transplant groups.
HEV Chronicity in Infected Patients
Among the patients diagnosed with HEV, 65.1% developed chronic hepatitis within three months, while 34.9% cleared the virus spontaneously. This suggests that, although infection is uncommon overall, chronic progression is frequent among those infected.
Influence of Immunosuppressive Therapy
Use of tacrolimus was independently associated with higher rates of chronic hepatitis, while mycophenolic acid was linked to a lower likelihood of chronicity. These associations may guide clinicians in evaluating risk factors, although causality cannot be assumed.
Ribavirin Therapy Outcomes
Ribavirin was the primary antiviral therapy. When treatment was continued until complete HEV RNA clearance from both serum and stool, a sustained virological response was achieved in 91.5% of treated patients.
A small subset required multiple treatment courses or did not respond. Some progressed to cirrhosis or died while still viraemic, including three deaths due to decompensated HEV-related cirrhosis.
Extrahepatic Complications
HEV infection was also associated with extrahepatic manifestations among infected patients: neurological complications occurred in 2.2%, and glomerular disease in 3.9%. These complications often resolved after viral clearance.
Clinical Implications
The study reinforces the importance of HEV screening in transplant recipients presenting with elevated liver enzymes, as well as careful consideration of antiviral therapy and immunosuppressive regimens.
For clinicians, the findings highlight the frequency of infection, the high rate of chronic hepatitis among those infected, and the role of ribavirin in management, while emphasizing the need for individualised patient care.
Reference
Kamar N et al. Two decades of hepatitis E in solid organ transplantation: A retrospective monocentric analysis. Hepatology. 2026;DOI:10.1097/HEP.0000000000001762.
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