背景:戊型肝炎是器官接受者的潜在严重感染,估计有三分之二的病例成为慢性病,并随后有肝硬化和死亡的风险。在欧洲,传播最常见的是通过食用生猪肉或未煮熟的猪肉,很少通过输血,还有实体器官移植后。在这里,我们描述了肾移植后传播的戊型肝炎病毒(HEV)感染病例,并回顾了描述实体器官移植传播的HEV感染病例的文献。
方法:肾移植3周后,6个月后,患者出现GGT和肝细胞溶解的孤立最小增加,导致基因型3c戊型肝炎的诊断,血浆病毒载量为6.5log10IU/mL。回想起来,HEVRNA在患者的血清中检测到从肝炎的发作,在捐献当天捐献者的血清中,病毒序列之间具有100%的同一性,确认供体来源的HEV感染。戊型肝炎有慢性病程,用利巴韦林治疗,治疗结束后10个月复发。
结论:自2012年以来,已经描述了7例通过实体器官移植传播HEV的病例,没有对供体进行系统筛查,全部诊断为慢性感染阶段;两名患者死亡。HEV器官供体传递可能被低估,并且对轻度肝功能损害可能与戊型肝炎有关的免疫功能低下患者的关注不足。由于这些患者的HEV感染可能很严重,随着证据的积累,我们认为,无论肝功能异常,都应对已故和活体捐献者进行系统的器官捐献者筛查,英国和西班牙的情况也是如此。2024年1月,法国移植监管机构对HEVRNA的器官供体实施了强制性筛查。
BACKGROUND: Hepatitis E is a potentially serious infection in organ recipients, with an estimated two-thirds of cases becoming chronic, and with a subsequent risk of cirrhosis and death. In Europe, transmission occurs most often through the consumption of raw or undercooked pork, more rarely through blood transfusion, but also after solid organ transplantation. Here we describe a case of Hepatitis E virus (HEV) infection transmitted following kidney transplantation and review the literature describing cases of HEV infection transmitted by solid organ transplantation.
METHODS: Three weeks after kidney transplantation, the patient presented with an isolated minimal increase in GGT and hepatic cytolysis 6 months later, leading to the diagnosis of genotype 3c hepatitis E, with a plasma viral load of 6.5 log10IU/mL. In retrospect, HEV RNA was detected in the patient\'s serum from the onset of hepatitis, and in the donor\'s serum on the day of donation, with 100% identity between the viral sequences, confirming donor-derived HEV infection. Hepatitis E had a chronic course, was treated by ribavirin, and relapsed 10 months after the end of treatment.
CONCLUSIONS: Seven cases of transmission of HEV by solid organ transplantation have been described since 2012 without systematic screening for donors, all diagnosed at the chronic infection stage; two patients died. HEV organ donor transmission may be underestimated and there is insufficient focus on immunocompromised patients in whom mild liver function test impairment is potentially related to hepatitis E. However, since HEV infection is potentially severe in these patients, and as evidence accumulates, we believe that systematic screening of organ donors should be implemented for deceased and living donors regardless of liver function abnormalities, as is already the case in the UK and Spain. In January 2024, the French regulatory agency of transplantation has implemented mandatory screening of organ donors for HEV RNA.