Hepatitis E virus (HEV) is responsible for acute and chronic autochthonous hepatitis in developed countries, particularly in Western Europe. Conversely to hepatitis B or C, the association between HEV and cryoglobulinemia is less documented. We prospectively evaluated the prevalence of cryoglobulinemia in HEV infected solid-organ-transplant recipients with resolving and chronic hepatitis and assessed the evolution of cryoglobulinemia in patients given ribavirin therapy.

Between November 2005 to June 2016, 89 patients with HEV infection were enrolled in the study: kidney- (n=56), liver- (n=24), cardiac- (n=4), pancreas- (n=1), lung- (n=1) and kidney-pancreas (n=3) transplant recipients. In this cohort, 39.3% of patients cleared HEV within the first 3 months after HEV diagnosis (n=35) while 60.3% developed chronic HEV infection (n=54).

Overall, the prevalence of cryoglobulinemia was 43.8% (n=39/89): 53.7% (n=29/54) in the group who developed a chronic hepatitis and 28.6% (n=10/35) in patients with resolving hepatitis. Cryoglobulinemia was significantly associated with chronic HEV infection appearance (OR=2.86, 95% CI, 1.078-8.068). No significant kidney function impairment or proteinuria was noticed in cryoglobulinemia positive patients. A 3-months ribavirin therapy (mean duration, 3.7 ±1.6 months) was given to all patients with chronic hepatitis and allowed HEV clearance in 78% of cases. After retreatment of relapsers, a sustained virological response was obtained for 95% of patients.

In 18 out of the 29 patients (62%) of cryoglobulinemia disappeared within ribavirin therapy. Nevertheless, 24% of cryoglobulinemia remained positive 6 months after the end of ribavirin therapy. Cryoglobulinemia is highly frequent during HEV infection in solid-organ-transplant recipients and could persist after viral clearance. Considering HEV endemicity in Western Europe with hyperendemic area, HEV markers should be check in case of cryoglobulinemia detection.

CITATION INFORMATION: Marion O, Abravanel F, Esposito L, Lhomme S, Del Bello A, Izopet J, Kamar N. Hepatitis E Virus-Associated Cryoglobulinemia in Solid-Organ-Transplant Recipients: A Prospective Study. Am J Transplant. 2017;17 (suppl 3).

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