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Multicenter Study
. 2020 Aug 22;71(5):1204-1211.
doi: 10.1093/cid/ciz953.

Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study

Nassim Kamar  1 , Florence Abravanel  2 , Patrick Behrendt  3 , Jörg Hofmann  4 , Georges Phillippe Pageaux  5 , Christelle Barbet  6 , Valérie Moal  7 , Lionel Couzi  8 , Thomas Horvatits  9 , Robert A De Man  10 , Elisabeth Cassuto  11 , Ahmed M Elsharkawy  12 , Annelies Riezebos-Brilman  13 , Anne Scemla  14 , Sophie Hillaire  15 , Mhairi C Donnelly  16 , Sylvie Radenne  17 , Johnny Sayegh  18 , Cyril Garrouste  19 , Jérôme Dumortier  20 , François Glowaki  21 , Marie Matignon  22 , Audrey Coilly  23 , Lucile Figueres  24 , Christiane Mousson  25 , Anne Minello  26 , Sébastien Dharancy  27 , Jean Philippe Rerolle  28 , Pascal Lebray  29 , Isabelle Etienne  30 , Peggy Perrin  31 , Mira Choi  4 , Olivier Marion  2 , Jacques Izopet  2 ; Hepatitis E Virus Ribavirin Study Group
Collaborators, Affiliations
Free article
Multicenter Study

Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study

Nassim Kamar et al. Clin Infect Dis. .
Free article

Abstract

Background: Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response.

Methods: Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29-1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25-18) months.

Results: After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event.

Conclusions: This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance.This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.

Keywords: anemia; hepatitis E virus; organ transplantation; ribavirin; sustained virological response.

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