title: Hepatitis E virus infection in hematopoietic stem cell transplant recipients.
abstract: OBJECTIVE
  Recipients of allogeneic stem cell transplantations are at risk of acquiring acute hepatitis E virus (HEV) infection, leading to chronicity. We review the incidence, sequela, extrahepatic manifestations, and treatment of hepatitis due to HEV infection in allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients.
  
  
  RESULTS
  HEV infection and progression to chronic HEV in alloHSCT recipients are recently described. Misdiagnosis of HEV in alloHSCT recipients occurs, with liver enzyme abnormalities often attributed to hepatic graft-versus-host disease or drug-induced liver injury. HEV infection may occur in HSCT donors and emphasizes the need for HEV screening not only after HSCT, but also in donors presenting with liver function disturbances. The discussion about HEV screening of blood products will continue. Extrahepatic manifestations of hepatitis E are described.
  
  
  CONCLUSIONS
  HEV RNA screening in alloHSCT recipients with elevated liver enzymes is advised. Intervention strategies should be considered in cases of acute or chronic HEV infection. The first-line approach includes reduction of immunosuppressive medication. Oral ribavirin is in experienced hands a reasonable well tolerated treatment option, although the optimal dose, duration, and quantitative goals of ribavirin treatment are still unknown. Further studies are needed to improve our understanding of HEV, including extrahepatic manifestations and evaluation of therapeutic options.
authors: aDepartment of Viroscience bDepartment of Hematology cDepartment of Hepatogastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Annemiek A
authors: AA
authors: van der Eijk
authors: Suzan D
authors: SD
authors: Pas
authors: Jan J
authors: JJ
authors: Cornelissen
authors: Robert A
authors: RA
authors: de Man
mesh_terms: D018380:Hematopoietic Stem Cell Transplantation; D016751:Hepatitis E; D016752:Hepatitis E virus; D006801:Humans; D016867:Immunocompromised Host; D066027:Transplant Recipients