Transfusion-transmitted hepatitis E virus infections: a risk for immunosuppressed patients

Question:

Hepatitis E is a major threat for immunosuppressed patients, as chronic HEV infection with possibly life-threatening complications might occur. The relevance of blood borne hepatitis E virus (HEV) infections for these patients has been discussed controversially within the last months and still requires further investigations.

Methods:

All immunosuppressed patients at our center with an HEV infection between 2011 and 2017 were retrospectively studied (n = 37). All blood products given to chronically HEV infected patients were retrospectively analyzed for the presence of HEV RNA by in-house realtime PCR (LLoD 12 IU/ml).

Results:

11 immunosuppressed patients (11/37, 30%) developed chronic HEV infection. In 4/11 (36%) we were able to identify an HEV positive blood donation as source of HEV transmission. Interestingly two of the chronic HEV infected patients, who were infected by blood-borne transmission, were heart transplant recipients. Both had been treated with a combination of plasmapheresis and rituximab for humoral rejection. As these cases attracted our attention to this proceeding, we tested the remaining 3 heart transplant recipients who were treated according to the same protocol at our center within the last 5 years but none of them had acquired persistent HEV infection.

Conclusions:

Blood products are a relevant source of HEV-infection for immunosuppressed individuals and in our series they are responsible for 36% of chronic HEV infections. Thus, we recommend screening of all blood products given to transplant or immunosuppressed recipients for HEV-RNA.