Acute hepatitis E as a cause of de-novo autoimmune hepatitis in liver transplant recipients

Introduction:

Hepatitis E virus (HEV) is a small RNA virus which is the major cause of acute hepatitis endemically in developing countries as well as its autochthonous form in Europe. The most usual course of HEV infection is the acute form which heals spontaneously. However, in some cases, hepatitis E infection may end fatal leading to acute liver failure (ALV) in patients with chronic liver disease or immunosuppression. More interesting is though the effect of this virus on the autoimmune systems, as a possible trigger of de-novo autoimmune diseases.

Patients and Methods:

In our retrospective study, 848 liver transplant recipients were tested for anti-HEV antibodies (IgG-, IgM) and RNA-PCR between January 2011 and December 2016. All patients have been tested independently from underlying cause of liver transplantation. In the follow-up examinations, we documented which of these patients developed de-novo autoimmune hepatitis (AIH) after contact with the hepatitis E virus.

Results:

Thirty liver transplant patients were diagnosed with acute hepatitis E infection, 153 patients have been in contact with the virus (only IgG titer positive), and 665 patients have been virus-naïve, respectively. However, a significantly higher percentage of patients with acute hepatitis E infection (16.7%, 5/30) developed de-novo autoimmune hepatitis compared to the percentage observed in patients with a past HEV-infection (2%, 3/153) and also compared to HEV-naïve patients (6%, 40/665; p = 0.004 and 0.038, respectively).

Conclusion:

Liver transplant patients with acute hepatitis E infection are more likely to develop a de-novo autoimmune hepatitis as compared to HEV naïve-patients.

Key words:

acute liver failure, de-novo autoimmune hepatitis, hepatitis E, liver transplantation