title: Hepatitis E virus: an underestimated opportunistic pathogen in recipients of allogeneic hematopoietic stem cell transplantation.
abstract: Hepatitis E virus (HEV) is increasingly acknowledged as a cause of hepatitis in healthy individuals as well as immunocompromised patients. Little is known of HEV infection in recipients of allogeneic hematopoietic stem cell transplantation (alloHSCT). Therefore, we set out to study the incidence and sequelae of HEV as a cause of hepatitis in a recent cohort of 328 alloHSCT recipients. HEV RNA was tested in episodes of liver enzyme abnormalities. In addition, HEV RNA and HEV serology were assessed pre- and post-alloHSCT. We found 8 cases (2.4%) of HEV infection, of which 5 had developed chronic HEV infection. Seroprevalence pre-alloHSCT was 13%. Four patients died with HEV viremia, with signs of ongoing hepatitis, having a median time of infection of 4.1 months. The 4 surviving patients cleared HEV after a median period of 6.3 months. One patient was diagnosed with HEV reactivation after a preceding infection prior to alloHSCT. Although the incidence of developing acute HEV post-alloHSCT is relatively low, the probability of developing chronic hepatitis in severely immunocompromised patients is high. Therefore, alloHSCT recipients should be screened pretransplantation by HEV serology and RNA. Furthermore, a differential diagnosis including hepatitis E is mandatory in all alloHSCT patients with severe liver enzyme abnormalities.
authors.affiliation: Department of Hematology, Erasmus Medical Center, Gravendijkwal 230, Rotterdam, The Netherlands.
authors.forename: Jurjen
authors.initials: J
authors.lastname: Versluis
authors.forename: Suzan D
authors.initials: SD
authors.lastname: Pas
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Agteresch
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Jolanda
authors.initials: J
authors.lastname: Maaskant
authors.forename: Marguerite E I
authors.initials: ME
authors.lastname: Schipper
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.forename: Annemiek A
authors.initials: AA
authors.lastname: van der Eijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D016751:Hepatitis E / Q000150:complications*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000302:isolation & purification; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012367:RNA, Viral