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

Nassim Kamar 1, 2 Florence Legrand-Abravanel 3, 4 Patrick Behrendt 5 Jörg Hofmann 6 Georges Phillippe Pageaux 7 Christelle Barbet 8 Valerie Moal 9, 10, 11 Lionel Couzi 12 Thomas Horvatits 13 Robert de Man 14 Elisabeth Cassuto 15 Ahmed Elsharkawy 16 Annelies Riezebos-Brilman 17 Anne Scemla 18 Sophie Hillaire 19 Mhairi Donnelly 20 Sylvie Radenne 21 Johnny Sayegh 22 Cyril Garrouste 23 Jérôme Dumortier 24 François Glowaki 25 Marie Matignon 26 Audrey Coilly 27 Lucile Figueres 28 Christiane Mousson 29 Anne Minello 30 Sébastien Dharancy 31 Jean Philippe Rerolle 32 Pascal Lebray 33 Isabelle Etienne 34 Peggy Perrin 35 Mira Choi 6 Marion Olivier 2 Jacques Izopet 2 J Bellière O. Cointault 1 Arnaud del Bello 36 L Espostio A Hebral L Lavayssière S Lhomme J Mansuy H Wedemeyer P Nickel M. Bismuth 7 K Stefic M. Buchler 8 L D’alteroche P. Colson 9, 11 S Bufton C Ramière P. Trimoulet 37 S Pischke E Todesco R Sberro Soussan C Legendre V. Mallet I Johannessen K Simpson 
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.
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Submitted on : Thursday, June 10, 2021 - 2:27:34 PM
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Nassim Kamar, Florence Legrand-Abravanel, Patrick Behrendt, Jörg Hofmann, Georges Phillippe Pageaux, et al.. Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study. Clinical Infectious Diseases, 2020, 71 (5), pp.1204-1211. ⟨10.1093/cid/ciz953⟩. ⟨hal-02465266⟩



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