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

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

doi:10.3201/eid2503.181563

Abstract

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.

Highlights

Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China
The Outbreak On posttransplantation day 127, detection of HEV RNA in plasma from a liver transplant recipient at Queen Mary Hospital led to a diagnosis of hepatitis E, at the time attributed to autochthonous foodborne acquisition
Because both kidneys and the heart had been harvested from this donor, samples were collected from the 3 corresponding recipients, and HEV RNA was detected in the plasma of all 3

Summary

Introduction

Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. 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. Data on the natural history and ribavirin responsiveness of HEV-4 infections in immunocompromised patients are limited. In August 2018, chronic HEV-4 infection developed in 2 transplant recipients who had received organs from a common donor. We conducted an investigation to 1) identify other infected recipients from the same donor, 2) confirm that the infection was donor derived, 3) investigate the natural history of HEV-4 infection, and 4) study outcomes of infected patients who received ribavirin

Methods

Results

Conclusion