Viral hepatitis in solid organ transplantation other than liver

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J Hepatol. 2011 Jan 14. [Epub ahead of print]

Viral hepatitis in solid organ transplantation other than liver.

Vallet-Pichard A, Fontaine H, Mallet V, Pol S.

Université Paris Descartes, Paris, France;Institut Cochin, Inserm (UMR-S1016),

CNRS (UMR 8104), Paris, France;APHP, Groupe Hospitalier Cochin Saint- de

, Unité d'Hépatologie.

Abstract

Transplantation is the best treatment for end-stage organ failure. Hepatitis

virus infections, mainly hepatitis B virus (HBV) and hepatitis C virus (HCV)

infections, still constitute a major problem because they are common in

allograft recipients and are a significant cause of morbidity and mortality

after transplantation. Recently, hepatitis E virus infection has been added as

an emergent cause of chronic hepatitis in organ transplantation. The prevalence

of HBV and HCV infections has markedly decreased in patients who are candidates

for transplantation since the introduction of screening, hygiene and prevention

measures, including systematic screening of blood and organ donations, use of

erythropoietin, compliance with universal hygiene rules, segregation of

HBV-infected patients from non-infected patients and systematic vaccination

against HBV. A liver biopsy is preferable to non-invasive biochemical and/or

morphological tests of fibrosis to evaluate liver fibrosis before and even after

transplantation. Treatment with entecavir or tenofovir is indicated in

HBV-infected dialyzed patients who have moderate or severe disease (⩾A2 or F2

on the Metavir scale) in preparation for renal transplantation. Due to the risks

of severe reactivation, fibrosing cholestatic hepatitis or histological

deterioration after transplantation, systematic use of nucleoside or nucleotide

analogues shortly before or at the time of transplantation is recommended

(tenofovir or entecavir are preferable to lamivudine) in all patients, whatever

the baseline histological evaluation. In HCV-infected dialyzed patients who are

not candidates for renal transplantation, the indication for antiviral therapy

is limited to significant fibrosis (fibrosis ⩾ 2 on the Metavir scale).

Treatment must be proposed to all candidates for renal transplantation, whatever

their baseline histopathology, and interferon-α should be used as monotherapy.

After transplantation, interferon- α is contraindicated but may be used in

patients for whom the benefits of antiviral treatment clearly outweigh the

risks, especially that of allograft rejection. All cirrhotic patients, notably

after solid organ transplantation, should be screened for hepatocellular

carcinoma. Sustained suppression of necro-inflammation may result in regression

of cirrhosis, which in turn may lead to decreased disease-related morbidity and

improved survival. Finally, due to the high mortality after renal

transplantation, active (namely without sustained viral suppression) cirrhosis

should be considered a contraindication to kidney transplantation, but an

indication to combined liver-kidney transplantation; on the contrary, inactive

(namely with sustained viral suppression) compensated cirrhosis may permit renal

transplantation alone. Organ transplantations other than kidney (cardiac or

pulmonary transplantations) involve the same diagnosis and therapeutic issues.

Copyright © 2011. Published by Elsevier B.V.

PMID: 21241754 [PubMed - as supplied by publisher]