title: Unique clinical courses of transfusion-transmitted hepatitis E in patients with immunosuppression.
abstract: The high prevalence of specific immunoglobulin G for hepatitis E virus (HEV) in Japanese people raises the possibility of a high incidence of HEV-viremic blood donors and therefore frequent transfusion-transmitted HEV (TT-HEV).
  
  
  
  TT-HEV cases established in Japan through hemovigilance and those published in the literature were collected. Infectivity of HEV-contaminated blood components and disease severity in relation to immunosuppression were investigated.
  
  
  
  Twenty established TT-HEV cases were recorded over the past 17 years. A lookback study verified that five of 10 patients transfused with known HEV-contaminated blood components acquired HEV infection. The minimal infectious dose of HEV through transfusion was 3.6 × 104IU. Nine of the 19 TT-HEV cases analyzed had hematologic diseases. Only two cases showed the maximal alanine aminotransferase level of more than 1000 U/L. Two patients with hematologic malignancy and two liver transplant recipients had chronic liver injury of moderate severity.
  
  
  
  The infectivity of HEV-contaminated components was 50%. Immunosuppression likely causes the moderate illness of TT-HEV, but it may lead to the establishment of chronic sequelae. Transfusion recipients, a population that is variably immunosuppressed, are more vulnerable to chronic liver injury as a result of TT-HEV than the general population is as a result of food-borne infection.
authors.affiliation: Japanese Red Cross Central Blood Institute.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Satake
authors.affiliation: Japanese Red Cross Central Blood Institute.
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsubayashi
authors.affiliation: Japanese Red Cross Central Blood Institute.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hoshi
authors.affiliation: Japanese Red Cross Blood Service Headquarters.
authors.forename: Rikizo
authors.initials: R
authors.lastname: Taira
authors.affiliation: Japanese Red Cross Blood Service Headquarters.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Furui
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.affiliation: Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, Department of Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University.
authors.forename: Masato
authors.initials: M
authors.lastname: Miyoshi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine.|Tamura Medical Clinic, Tokyo, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Tamura
authors.affiliation: Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Fuse
authors.affiliation: Japanese Red Cross Blood Service Headquarters.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tadokoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood*; D001782:Blood Donors; D058731:Blood Safety; D001803:Blood Transfusion; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000628:therapy; D016751:Hepatitis E / Q000097:blood* / Q000453:epidemiology / Q000635:transmission*; D016752:Hepatitis E virus; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007165:Immunosuppression Therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G