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Peer-reviewedCC BY 4.0Infection

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

  • Sven Pischke1,2
  • L. Kwoka1
  • A. Nolde3
  • T. B. Huber4
  • M. Sterneck1
  • F. Berisha5
  • T. Fründt1
  • L. Fischer6
  • M. J. Barten7
  • S. Blankenberg5
  • M. Kluger4
  • M. Mahmud4
10 more authors
  • M. Rybczynski5
  • S. Huber1
  • A. Lohse1,2
  • H. Reichenspurner7
  • B. Sill7
  • A. Bernhardt7
  • F. Grahammer4
  • H. F. E. Klose3
  • J. Schulze zur Wiesch1,2
  • S. Polywka8
8 affiliations
  1. 1I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Partner Site, Hamburg, Germany
  3. 3Abteilung für Pneumologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  4. 4III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  5. 5Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
  6. 6Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. 7Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  8. 8Microbiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{pischke2026lower,
  title = {{Lower hepatitis E clearance rates in thoracic organ recipients compared to visceral organ recipients: an effect of stronger immunosuppression?}},
  author = {Sven Pischke and L. Kwoka and A. Nolde and T. B. Huber and M. Sterneck and F. Berisha and T. Fründt and L. Fischer and M. J. Barten and S. Blankenberg and M. Kluger and M. Mahmud and M. Rybczynski and S. Huber and A. Lohse and H. Reichenspurner and B. Sill and A. Bernhardt and F. Grahammer and H. F. E. Klose and J. Schulze zur Wiesch and S. Polywka},
  journal = {Infection},
  year = {2026},
  month = aug,
  doi = {10.1007/s15010-026-02892-x},
  url = {https://doi.org/10.1007/s15010-026-02892-x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Lower hepatitis E clearance rates in thoracic organ recipients compared to visceral organ recipients: an effect of stronger immunosuppression?
AU  - Sven Pischke
AU  - L. Kwoka
AU  - A. Nolde
AU  - T. B. Huber
AU  - M. Sterneck
AU  - F. Berisha
AU  - T. Fründt
AU  - L. Fischer
AU  - M. J. Barten
AU  - S. Blankenberg
AU  - M. Kluger
AU  - M. Mahmud
AU  - M. Rybczynski
AU  - S. Huber
AU  - A. Lohse
AU  - H. Reichenspurner
AU  - B. Sill
AU  - A. Bernhardt
AU  - F. Grahammer
AU  - H. F. E. Klose
AU  - J. Schulze zur Wiesch
AU  - S. Polywka
PY  - 2026
DA  - 2026/08/11
JO  - Infection
DO  - 10.1007/s15010-026-02892-x
UR  - https://doi.org/10.1007/s15010-026-02892-x
AB  - 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.
SN  - 0300-8126
SN  - 1439-0973
ER  -