Reduction of immunosuppressants fails to clear hepatitis E virus infection in a heart transplant recipient.

Hepatitis E virus (HEV) infection poses a significant public health burden in immunosuppressed individuals. Here, we report a 41-year-old male patient with a history of orthotopic heart transplantation, who develop HEV genotype 4 (subtype 4d) infection one-and-a-half-year post-transplantation. The patient exhibits a very weak anti-HEV IgG response. Abnormal liver function parameters persist for one month without evidence of clinical improvement. Therefore, the immunosuppressant dosage is halved to promote effective antiviral response. The anti-HEV IgG response gradually increases; however, abnormal liver function parameters persist into the second month, and HEV infection fails to clear. The patient is administered ribavirin at a dose of 600 mg/d, and by the third month, the viral load significantly decreases. By the fourth month, HEV infection is successfully cleared, liver function parameters returned to normal, and no viral reactivation is observed through the eighth month. This work highlights therapeutic approaches for managing HEV infection in solid organ transplantation (SOT) recipients.