Weide, H.Y. van der (2012) Chronic Hepatitis E in Lung and Heart Transplant Recipients. thesis, Medicine.
Full text available on request.Abstract
Introduction: Hepatitis E is one of the most important causes of acute viral hepatitis in developing countries. However, in developed countries, hepatitis E is less common. Hepatitis E virus (HEV) genotype 3 is the causative agent of non-travel related infections in the Netherlands. HEV was always thought to only cause acute infections. Nevertheless, in 2008, the first cases of chronic hepatitis E in immunocompromised individuals have been published. The prevalence of hepatitis E in transplant populations appears to be low. However, complications can be severe since cirrhosis may develop. No studies have previously described the occurrence of chronic HEV in lung transplant recipients. Only 1 case report about chronic hepatitis E in a heart transplant recipient has been published. The aim of this study is to investigate the prevalence of (chronic) hepatitis E in lung and heart transplant recipients. Patients and methods: We studied 205 lung and 74 heart transplant recipients with a follow-up of at least one year after transplantation, for the presence of elevated liver tests at the most recent out-patient control. Liver test abnormalities were defined as an aspartate aminotransferase > 40 U/L, alanine aminotransferase > 44 U/L, alkaline phosphatase > 220 U/L, gamma glutamyl transpeptidase > 220 U/L (men) or > 160 (women). Subsequently freeze-stored blood samples were tested for the presence of HEV RNA by means of real-time RT-PCR. Patients positive for HEV RNA were further studied to determine the duration of the hepatitis E infection. Results: Elevated liver tests were present in 11% and 8% of the lung and heart transplant recipients, respectively. Of these patients, chronic hepatitis E was found to be present in 4 (18%) lung transplant recipients (2% of total) and in 1 (17%) heart transplant patient (1% of total). In the lung transplant recipients, the median duration of HEV infection was 1.2 years (range 0.8 – 4.2 years). The duration of the HEV viremia in the heart transplant patient was 0.9 years. Liver test elevations were mild in all cases. So far, none of the patients developed cirrhosis. Conclusion: The prevalence of chronic hepatitis E in lung and heart transplant recipients seems to be comparable with prevalence data in liver, kidney, and kidney-pancreas transplant patients. The disease course was mild in all cases. Chronic HEV infection has to be considered in the differential diagnosis of lung and heart transplant recipients with liver test abnormalities.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor and Haagsma, Dr. E.B. and Department of Gastroenterology and Hepatology, University Me |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/608 |
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