Successful Treatment of Chronic Hepatitis E After an Orthotopic Liver Transplant With Ribavirin Monotherapy.

Abstract

OBJECTIVES:

Hepatitis E virus infection is increasingly reported as a cause of chronic hepatitis in organ transplant recipients. Besides reduction of immunosuppressive therapy or pegylated-interferon therapy, promising results have been reported for ribavirin monotherapy of hepatitis E virus after kidney transplant. To our knowledge, this is the first report of a successful ribavirin monotherapy for chronic hepatitis E virus infection after and orthotopic liver transplant.

MATERIALS AND METHODS:

This is a case report of a 55-year-old man with a diagnosis of chronic hepatitis E (genotype 3f) 26 months after an orthotopic liver transplant. A reduction of immunosuppressive therapy was not tolerated, and the patient did not qualify for pegylated-interferon therapy. Because of progressively elevated liver transaminases accompanied by histologic changes in the liver allograft, ribavirin monotherapy was undertaken for 16 weeks.

RESULTS:

We saw a decrease in liver enzymes after 1 week of ribavirin monotherapy. Hepatitis E virus RNA anti-HEV-IgM were tested after 8 weeks of ribavirin therapy, and were both negative. Antiviral therapy was continued for 16 weeks, and hepatitis E virus RNA remained undetectable; there also was a significant decrease in liver transaminases levels to normal values. In the 8-week and 8-month follow-ups at the end of antiviral therapy, the patient presented with normal liver enzymes and no detectable hepatitis E virus RNA.

CONCLUSIONS:

In conclusion, successful therapy of chronic hepatitis E after an orthotopic liver transplant may be achieved by ribavirin monotherapy and should be considered in patients who are sensitive to a reduction of immunosuppressive therapy or pegylated-interferon therapy.

• Authors: Fritz Klein, Ruth Neuhaus, Jörg Hofmann, Birgit Rudolph, Peter Neuhaus, Marcus Bahra
• Journal: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation (Exp Clin Transplant) Vol. 13 Issue 3 Pg. 283-6 (Jun 2015) ISSN: 2146-8427 [Electronic] Turkey
• PMID: 24779678 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antiviral Agents
• Immunosuppressive Agents
• Ribavirin

Topics

• Antiviral Agents (therapeutic use)
• Biopsy
• Hepatitis E (diagnosis, drug therapy, immunology, virology)
• Hepatitis, Chronic (diagnosis, drug therapy, immunology, virology)
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (adverse effects)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Opportunistic Infections (diagnosis, drug therapy, immunology, virology)
• Ribavirin (therapeutic use)
• Time Factors
• Treatment Outcome
• Viral Load