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Hepatitis E virus is an infrequent but potentially serious infection in allogeneic hematopoietic stem cell transplant recipients

Journal article
Authors L. Swartling
Rickard Nordén
Ebba Samuelsson
K. Boriskina
D. Valentini
Johan Westin
Helene Norder
E. Sparrelid
P. Ljungman
Published in Bone Marrow Transplantation
ISSN 0268-3369
Publication year 2020
Published at Institute of Biomedicine, Department of Infectious Medicine
Language en
Keywords versus-host-disease, donor, Biophysics, Oncology, Hematology, Immunology, Transplantation
Subject categories Infectious Medicine, Cancer and Oncology, Immunology in the medical area, Hematology


Hepatitis E virus (HEV) can cause chronic infection and liver cirrhosis in immunocompromised individuals. The frequency and clinical importance of HEV was studied retrospectively in a cohort of 236 Swedish allogeneic hematopoietic stem cell transplantation (HSCT) recipients. In blood samples collected at 6 months after HSCT, HEV RNA was identified in 8/236 (3.4%) patients, and 11/236 (4.7%) patients had detectable anti-HEV IgG and/or IgM, eight of whom were HEV RNA negative. Two of the patients with positive HEV RNA died with ongoing signs of hepatitis: one of acute liver and multiple organ failure, the other of unrelated causes. The remaining six patients with HEV RNA had cleared the infection at 7-24 (median 8.5) months after HSCT. HEV infection was associated with elevated alanine aminotransferase at 6 months after HSCT (OR 15, 1.3-174, p = 0.03). Active graft-versus-host disease of the liver at 6 months after HSCT was present in 3/8 (38%) patients with HEV RNA, but was not significantly associated with HEV infection. In conclusion, HEV infection is an important differential diagnosis in patients with elevated liver enzymes after HSCT. Although spontaneous clearance was common, the clinical course may be severe.

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