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

• Published in: Emerging infectious diseases 2019-03, Vol.25 (3), p.425-433
• Main Authors: Sridhar, Siddharth, Cheng, Vincent C C, Wong, Shuk-Ching, Yip, Cyril C Y, Wu, Shusheng, Lo, Anthony W I, Leung, Kit-Hang, Mak, Winger W N, Cai, Jianpiao, Li, Xin, Chan, Jasper F W, Lau, Susanna K P, Woo, Patrick C Y, Lai, Wai-Ming, Kwan, Tze-Hoi, Au, Timmy W K, Lo, Chung-Mau, Wong, Sally C Y, Yuen, Kwok-Yung
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antithymocyte globulin; Basiliximab; Child; chronic hepatitis; Development and progression; Disease Outbreaks; Disease transmission; Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018; EDTA; Everolimus; Female; Genetic aspects; Genotype; Health aspects; hepatitis; Hepatitis E; Hepatitis E - diagnosis; Hepatitis E - epidemiology; Hepatitis E - history; Hepatitis E - virology; hepatitis E virus; Hepatitis E virus - classification; Hepatitis E virus - genetics; History, 21st Century; Hong Kong - epidemiology; Humans; Hypertension; immune system; Immunocompromised host; Immunoglobulin G; Immunohistochemistry; Immunotherapy; Infection; Liver transplantation; Male; Middle Aged; Molecular Typing; Organ transplant recipients; Organ Transplantation; Phylogeny; Portal hypertension; Ribavirin; Sequence Analysis, DNA; Serologic Tests; Surgery; Tissue donation; Tissue Donors; transplantation; Virus diseases
• ISSN: 1080-6040; 1080-6059; 1080-6059
• DOI: 10.3201/eid2503.181563

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.