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

Figures

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  Fig. 1. Liver function parameters monitoring. (A) ALT, AST, γ-GGT and ALP monitoring. The Y-axis on the left represents ALT, AST and γ-GGT level (IU/L); The Y-axis on the right represents ALP level (IU/L). The red legend indicates level of ALT (circles), AST (squares) and γ-GGT (triangles). The blue legend indicates level of ALP (triangles). (B) TBIL, IBIL, TBA and DBIL monitoring. The Y-axis on the left represents TBIL, IBIL and TBA (μmol/L); The Y-axis on the right represents DBIL level (μmol/L). The red legend indicates level of TBIL (circles), IBIL (squares) and TBA (triangles). The blue legend indicates level of DBIL (triangles). (C) Prealbumin and albumin monitoring. The Y-axis on the left represents prealbumin level (mg/L); The Y-axis on the right represents albumin level (g/L). The red legend indicates level of prealbumin (circles). The blue legend indicates level of albumin (squares).

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  Fig. 2. Phylogenetic tree of full-length HEV genome. Phylogenetic tree was reconstructed by the neighbor-joining method based on a full-length gene of HEV. Viral genotype (subtype), GenBank accession number, virus host, country of origin, and year of collection are indicated. Sequences obtained in the patient with a history of orthotopic heart transplantation are highlighted with a red triangle (GenBank no. PV534972). Bootstrap values > 70 are shown.

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  Fig. 3. Virological and serological testing for HEV infection. (A) Virological testing for HEV infection in the patient with a history of orthotopic heart transplantation. The Y-axis on the left represents viral load (copies/mL); The Y-axis on the right represents viral antigen level (S/CO). The red legend indicates HEV RNA of serum (circles) and stool (squares). The blue legend indicates HEV antigen of serum (circles), stool (squares) and urine (triangles). (B) Serological testing for HEV infection in the patient with a history of orthotopic heart transplantation. The Y-axis on the left represents anti-HEV IgM level (OD450/630); The Y-axis on the right represents anti-HEV IgG level (OD450/630). The red legend indicates anti-HEV IgM of serum (circles). The blue legend indicates anti-HEV IgG of serum (circles).

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  Fig. 4. The follow-up process of the patient's diagnosis and treatment and timelines of major clinical events.