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.