Hepatitis E Virus Infection in Lung Transplant Recipients: A Case Series

Area of Science:

• Hepatology
• Transplant Surgery
• Infectious Diseases

Background:

• Hepatitis E virus (HEV) causes acute and chronic hepatitis globally.
• HEV genotypes 1 & 2 cause epidemics in endemic areas; genotypes 3 & 4 are zoonotic in non-endemic regions.
• HEV is known in solid organ transplant recipients, but data in lung transplant patients is scarce.

Observation:

• This study presents the first three cases of HEV infection in lung transplant recipients at our institution.
• Patients presented with abnormal liver enzymes post-transplant, with no history of travel outside Spain.
• Diagnosis utilized in-house PCR and ELISA (IgG/IgM).

Findings:

• One untreated patient died from progressive hepatic disease due to HEV complications.
• Two patients received ribavirin treatment for HEV; one discontinued due to anemia.
• HEV infection should be considered in lung transplant recipients with abnormal liver function tests.

Implications:

• Early HEV detection and treatment in lung transplant recipients can prevent liver failure and reduce mortality.
• Further prospective seroprevalence studies are needed to understand HEV epidemiology in this patient population.
• HEV should be included in the differential diagnosis for abnormal liver enzymes post-lung transplantation.