Lower hepatitis E clearance rates in thoracic organ recipients compared to visceral organ recipients: an effect of stronger immunosuppression?

BACKGROUND AND AIMS: Hepatitis E virus (HEV) infection is a significant concern for solid organ transplant (SOT) recipients. However, the extent of this disease among recipients of different organs remains unclear. METHODS: This retrospective cohort study reviewed 63 adult SOT patients with PCR-confirmed HEV infection, including liver, kidney, heart, and lung transplant recipients. RESULTS: Chronic HEV infection (viral persistence beyond three months) was observed in 64% of infected patients, with a significantly higher occurrence in thoracic organ recipients compared to abdominal organ recipients. Ribavirin therapy, started in 40 patients with chronic infection, resulted in a sustained virological response in 78%. However, thoracic organ recipients exhibited notably lower clearance rates (55%) than abdominal organ recipients (91%). The use of tacrolimus, cyclosporine A, mycophenolate mofetil, azathioprine, or steroids was not linked to the development or eventual clearance of chronic infection. Nonetheless, 4 out of 25 patients (16%) receiving everolimus cleared the infection. spontaneously, compared to 20 of 39 patients (51%) on regimens without everolimus (p = 0.007). Low-dose maintenance ribavirin therapy proved effective in stabilizing liver function and, in some cases, achieving viral clearance. Despite treatment, four patients with chronic HEV infection died from cirrhosis. CONCLUSION: This study emphasizes the need for customized treatment Strategies for HEV infection in SOT recipients, highlighting the limitations of serology, the variable response depending on transplant type, and the potential role of long-term ribavirin therapy.