Risk factors for ribavirin treatment failure in Asian organ transplant recipients with chronic hepatitis E infection

Table 1 Demographics and clinical characteristics of 10 patients

Variables	Value
Age, yr
Mean	47
Range	34-59
Male gender, n (%)	8 (80)
Type of organ transplant, n (%)
Liver	4 (40)
Kidney	5 (50)
Bone Marrow	1 (10)
Time from transplant to unexplained transaminitis in mo
Median	41.5
Range	0.5-276
Time from transplant to diagnosis of HEV in mo
Median	43.0
Range	0.5-276
Immunosuppressive therapy at the diagnosis of HEV, n (%)
Tacrolimus	6 (60)
Cyclosporin	1 (10)
Mycophenolate	6 (60)
Azathioprine	3 (30)
Prednisolone	7 (70)
Sirolimus	1 (10)
BEAM-R	1 (10)
(carmustine, etoposide, cytarabine, and melphalan – rituximab)
Peak alanine transaminase, as U/L
Median	213
Range	133-8127
Peak aspartate aminotransferase, as U/L
Median	203
Range	84-2591
Baseline estimated glomerular filtration rate, as mL/min
Median	63
Range	27-108
Baseline creatinine, as μmol/L
Median	141
Range	66-323

HEV: Hepatitis E virus.

Table 2 Comparison of clinical, biochemical and virological factors between the sustained responders and relapsers/delayed responders of ribavirin therapy

	Sustained responders, n = 4	Relapsers/ delayed responders, n = 5
Type of transplant	3 liver transplants, 1 bone marrow transplant	Kidney transplant
Mean age in yr	42 (15–58)	48 (17–66)
Males	3	4
Mean Time from transplant to HEV infection	40.3 mo (7-132 mo)	130.7 mo (3.5-204 mo)
Mean HEV viral load peak, as IU/mL	6.0 x 106	1.2 x 107
Mean daily dose of Prednisolone at time of infection, n = 6	13.5 mg (n = 2)	9.6 mg (n = 4)
Mean level of Tacrolimus at time of infection, as μg/L for n = 5	5.5 (6.4, 7.4, 2.8) n = 3	8.6 (9.5, 7.7) n = 2
Mean peak ALT, as U/L	402 U/L (223-766)	169 U/L (133–202)
Mean peak AST, as U/L	374 U/L (186-818)	132 U/L (84-219)
Lowest eGFR, as mL/min	49 (34 to 85)	32 (11-68)
Mean ribavirin dose, as mg/kg body weight, at initiation	10.3 mg/kg body weight (6.9- 13.5)	7.8 mg/kg body weight (2.7-11.9)
Haemoglobin drop	3.3 g/dL	3.5 g/dL
Resolution of Transaminitis after starting treatment	15 d	35 d
	(12-21)	(14-70)
Mean time to viral clearance after starting ribavirin	8.5 wk (8-11)	9.3 wk (5-12), n = 4
HEV recurrence	None in all 4 patients (including the non-adherent subject after she became compliant to ribavirin Rx)	Yes in 4 patients + 1 patient with persistent viremia

HEV: Hepatitis E virus; eGFR: Estimated glomerular filtration rate; ALT: Alanine transaminase; AST: Aspartate aminotransferase.