Emerging Infectious Diseases (Mar 2019)

Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018

  • Siddharth Sridhar,
  • Vincent C.C. Cheng,
  • Shuk-Ching Wong,
  • Cyril C.Y. Yip,
  • Shusheng Wu,
  • Anthony W.I. Lo,
  • Kit-Hang Leung,
  • Winger W.N. Mak,
  • Jianpiao Cai,
  • Xin Li,
  • Jasper F.W. Chan,
  • Susanna K.P. Lau,
  • Patrick C.Y. Woo,
  • Wai-Ming Lai,
  • Tze-Hoi Kwan,
  • Timmy W.K. Au,
  • Chung-Mau Lo,
  • Sally C.Y. Wong,
  • Kwok-Yung Yuen

DOI
https://doi.org/10.3201/eid2503.181563
Journal volume & issue
Vol. 25, no. 3
pp. 425 – 433

Abstract

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Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.

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