Elsevier

Journal of Hepatology

Volume 61, Issue 6, December 2014, Pages 1418-1429
Journal of Hepatology

Frontiers in Liver Transplantation
The impact of hepatitis E in the liver transplant setting

https://doi.org/10.1016/j.jhep.2014.08.047Get rights and content
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open access

Summary

Hepatitis E virus (HEV) infection has been identified as a cause of graft hepatitis in liver transplant recipients. The true frequency and clinical importance of HEV infections after liver transplantations is a matter of debate. It is proposed that consumption of HEV-contaminated undercooked meat is a main source for HEV infections in developed countries – which might also account for some hepatitis E cases after organ transplantation. However, HEV is also transmitted by transfusion of blood products, likely representing a previously underestimated risk particularly for patients in the transplant setting. HEV infection can take chronic courses in immunocompromised individuals, associated in some cases with rapid progression to cirrhosis within 1–2 years of infection. Diagnosis in transplanted patients is based on HEV RNA testing as antibody assays are not sensitive enough. Selection of immunosuppressive drugs is important as different compounds may influence viral replication and the course of liver disease. Ribavirin has antiviral activity against HEV and should be administered for at least three months in chronically infected individuals; however, treatment failure may occur. HEV infections have also been linked to a variety of extrahepatic manifestations both during and after resolution of infection.

In this review we summarize the emerging data on hepatitis E with a particular focus on the importance of HEV infections for liver transplant recipients.

Abbreviations

HEV
hepatitis E virus
HVR
hypervariable region
ORF
open-reading frame
GBS
Guillain–Barrè syndrome

Keywords

Hepatitis E
HEV
Liver transplantation
Treatment

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