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Virale Infektionen bei Lebertransplantierten

Viral infections in liver transplantation recipients

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die Lebertransplantation ist ein Routineverfahren zur Behandlung von Patienten mit fortgeschrittener Leberzirrhose oder hepatozellulären Karzinomen. Die Morbidität und Mortalität im Rahmen einer Lebertransplantation konnte in den letzten Jahrzehnten durch Fortschritte in Operationstechniken, bildgebenden Verfahren und durch neue Immunsuppressiva deutlich verbessert werden. Allerdings reduzieren diese Immunsuppressiva nicht nur das Risiko einer Abstoßung des Spenderorgans, sondern erhöhen auch die Prädisposition für verschiedenste Infektionen oder können den Verlauf von chronischen Infektionen bei Organempfängern beeinflussen. Dieser Artikel gibt eine Übersicht über die wichtigsten Virusinfektionen bei Lebertransplantierten und die klinischen Implikationen.

Abstract

Liver transplantation has become a standard therapy for patients with advanced liver disease and hepatocellular carcinoma. The long-term outcome after liver transplantation improved due to improvements in surgical techniques, imaging and better immunosuppressive agents. Still, immunosuppression may increase the risk for infections and may alter the course of chronic infections in organ recipients. This article summarizes the current knowledge on viral infection after liver transplantation and therapeutic options.

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Literatur

  1. Arguedas MR, Johnson A, Eloubeidi MA et al (2001) Immunogenicity of hepatitis A vaccination in decompensated cirrhotic patients. Hepatology 34:28–31

    Article  CAS  Google Scholar 

  2. Behrendt P, Steinmann E, Manns MP et al (2014) The impact of hepatitis E in the liver transplant setting. J Hepatol 61:1418–1429

    Article  Google Scholar 

  3. Belli LS, Duvoux C, Berenguer M et al (2017) ELITA consensus statements on the use of DAAs in liver transplant candidates and recipients. J Hepatol 67:585–602

    Article  CAS  Google Scholar 

  4. Cornberg M, Protzer U, Petersen J et al (2011) Prophylaxis, diagnosis and therapy of hepatitis B virus infection—the German guideline. Z Gastroenterol 49:871–930

    Article  CAS  Google Scholar 

  5. Dalton HR, Kamar N, Baylis SA et al (2018) EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol 68:1256–1271

    Article  Google Scholar 

  6. Deterding K, Wedemeyer H (2019) Beyond pegylated Interferon-Alpha: new treatments for hepatitis delta. AIDSRev 21:126–134

    Article  Google Scholar 

  7. Fishman JA, Emery V, Freeman R et al (2007) Cytomegalovirus in transplantation—challenging the status quo. Clin Transplant 21:149–158

    Article  Google Scholar 

  8. Friebus-Kardash J, Gackler A, Kribben A et al (2019) Successful early sofosbuvir-based antiviral treatment after transplantation of kidneys from HCV-viremic donors into HCV-negative recipients. Transpl Infect Dis 21:e13146

    Article  Google Scholar 

  9. Giersch K, Bhadra OD, Volz T et al (2019) Hepatitis delta virus persists during liver regeneration and is amplified through cell division both in vitro and in vivo. Gut 68:150–157

    Article  CAS  Google Scholar 

  10. Herman D, Han H (2017) Cytomegalovirus in liver transplant recipients. Curr Opin Organ Transplant 22:345–350

    Article  Google Scholar 

  11. Herrmann A, Sandmann L, Adams O et al (2018) Role of BK polyomavirus (BKV) and Torque teno virus (TTV) in liver transplant recipients with renal impairment. J Med Microbiol 67:1496–1508

    Article  CAS  Google Scholar 

  12. Herzer K, Gerken G, Kroy D et al (2018) Impact of direct-acting antiviral therapy on the need for liver transplantation related to hepatitis C in Germany. J Hepatol 69:982–984

    Article  Google Scholar 

  13. Jaksch P, Kundi M, Görzer I et al (2018) Torque Teno virus as a novel biomarker targeting the efficacy of Immunosuppression after lung transplantation. J Infect Dis 218:1922–1928

    Article  Google Scholar 

  14. Jiang AA, Greenwald HS, Sheikh L et al (2019) Predictors of acute liver failure in patients with acute hepatitis A: an analysis of the 2016–2018 san Diego county hepatitis A outbreak. Open Forum Infect Dis 6:ofz467

    Article  Google Scholar 

  15. Kamar N, Abravanel F, Behrendt P et al (2019) Ribavirin for hepatitis E virus infection after organ transplantation: a large European retrospective multicenter study. Clin Infect Dis. https://doi.org/10.1093/cid/ciz953

    Article  PubMed  Google Scholar 

  16. Kamar N, Izopet J, Pavio N et al (2017) Hepatitis E virus infection. Nat Rev Dis Primers 3:17086

    Article  Google Scholar 

  17. Korth J, Verheyen J, Witzke O (2016) BK-Polyomavirus-Reaktivierung nach Nierentransplantation. Nephrologe 11:402–407

    Article  Google Scholar 

  18. Lampertico P, Agarwal K, Berg T et al (2017) EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 67:370–398

    Article  Google Scholar 

  19. Loomba R, Liang TJ (2017) Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology 152:1297–1309

    Article  Google Scholar 

  20. Manka P, Bechmann LP, Coombes JD et al (2015) Hepatitis E virus infection as a possible cause of acute liver failure in Europe. Clin Gastroenterol Hepatol 13:1836–1842.e2 (quiz e1157–1838)

    Article  Google Scholar 

  21. Marcelin JR, Beam E, Razonable RR (2014) Cytomegalovirus infection in liver transplant recipients: updates on clinical management. WJG 20:10658–10667

    Article  Google Scholar 

  22. Mumtaz K, Faisal N, Husain S et al (2015) Universal prophylaxis or preemptive strategy for cytomegalovirus disease after liver transplantation: a systematic review and meta-analysis. Am J Transplant 15:472–481

    Article  CAS  Google Scholar 

  23. Phan TL, Lautenschlager I, Razonable RR et al (2018) HHV‑6 in liver transplantation: a literature review. Liver Int 38:210–223

    Article  Google Scholar 

  24. Pischke S, Behrendt P, Bock CT et al (2014) Hepatitis E in Germany—an under-reported infectious disease. Dtsch Arztebl Int 111:577–583

    PubMed  PubMed Central  Google Scholar 

  25. Pischke S, Gösling J, Engelmann I et al (2012) High intrahepatic HHV‑6 virus loads but neither CMV nor EBV are associated with decreased graft survival after diagnosis of graft hepatitis. J Hepatol 56:1063–1069

    Article  Google Scholar 

  26. Roche B, Roque-Afonso AM, Nevens F et al (2015) Rational basis for optimizing short and long-term hepatitis B virus prophylaxis post liver transplantation: role of hepatitis B immune globulin. Transplantation 99:1321–1334

    Article  CAS  Google Scholar 

  27. Sarrazin C, Zimmermann T, Berg T et al (2018) Prophylaxis, diagnosis and therapy of hepatitis-C-virus (HCV) infection: the German guidelines on the management of HCV infection—AWMF-Register-No.: 021/012. Z Gastroenterol 56:756–838

    Article  Google Scholar 

  28. Schütte A, Ciesek S, Wedemeyer H et al (2019) Influenza virus infection as precipitating event of acute-on-chronic liver failure. J Hepatol 70:797–799

    Article  Google Scholar 

  29. Wedemeyer H, Manns MP (2010) Epidemiology, pathogenesis and management of hepatitis D: update and challenges ahead. Nature reviews. Gastroenterol Hepatol 7:31–40

    Google Scholar 

  30. Wedemeyer H, Yurdaydin C, Hardtke S et al (2019) Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): a randomised, placebo controlled, phase 2 trial. Lancet Infect Dis 19:275–286

    Article  CAS  Google Scholar 

  31. Westhölter D, Hiller J, Denzer U et al (2018) HEV-positive blood donations represent a relevant infection risk for immunosuppressed recipients. J Hepatol 69:36–42

    Article  Google Scholar 

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Danksagung

Die Autoren danken Herrn Martin Trippler für die editorische Unterstützung beim Erstellen des Manuskriptes.

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Authors and Affiliations

  1. Institut für Medizinische Virologie, Universitätsklinikum Frankfurt, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main, Deutschland

    S. Ciesek

  2. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland

    H. Wedemeyer

  3. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    H. Wedemeyer

Authors
  1. S. Ciesek
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Correspondence to S. Ciesek.

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Interessenkonflikt

S. Ciesek gibt an, dass kein Interessenkonflikt besteht. H. Wedemeyer hat Honorare erhalten für Beratung und/oder Vortragstätigkeit von den Firmen Abbott, AbbVie, Bayer, BMS, Gilead, Janssen, MSD/Merck, MyrGmbH, Roche, Siemens.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Redaktion

M. Müller-Schilling, Regensburg

A. Stallmach, Jena

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Ciesek, S., Wedemeyer, H. Virale Infektionen bei Lebertransplantierten. Gastroenterologe 15, 227–234 (2020). https://doi.org/10.1007/s11377-020-00434-x

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  • DOI: https://doi.org/10.1007/s11377-020-00434-x

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