Department of Hematology, Erasmus Medical Center, Gravendijkwal 230, Rotterdam, The Netherlands.
Blood. 2013 Aug 8;122(6):1079-86. doi: 10.1182/blood-2013-03-492363. Epub 2013 Jun 21.
Hepatitis E virus (HEV) is increasingly acknowledged as a cause of hepatitis in healthy individuals as well as immunocompromised patients. Little is known of HEV infection in recipients of allogeneic hematopoietic stem cell transplantation (alloHSCT). Therefore, we set out to study the incidence and sequelae of HEV as a cause of hepatitis in a recent cohort of 328 alloHSCT recipients. HEV RNA was tested in episodes of liver enzyme abnormalities. In addition, HEV RNA and HEV serology were assessed pre- and post-alloHSCT. We found 8 cases (2.4%) of HEV infection, of which 5 had developed chronic HEV infection. Seroprevalence pre-alloHSCT was 13%. Four patients died with HEV viremia, with signs of ongoing hepatitis, having a median time of infection of 4.1 months. The 4 surviving patients cleared HEV after a median period of 6.3 months. One patient was diagnosed with HEV reactivation after a preceding infection prior to alloHSCT. Although the incidence of developing acute HEV post-alloHSCT is relatively low, the probability of developing chronic hepatitis in severely immunocompromised patients is high. Therefore, alloHSCT recipients should be screened pretransplantation by HEV serology and RNA. Furthermore, a differential diagnosis including hepatitis E is mandatory in all alloHSCT patients with severe liver enzyme abnormalities.
戊型肝炎病毒（HEV）在健康人群以及免疫功能低下患者中作为肝炎病因的地位日益得到认可。异基因造血干细胞移植（alloHSCT）受者的 HEV 感染情况知之甚少。因此，我们着手研究最近 328 例 alloHSCT 受者中作为肝炎病因的 HEV 感染发生率和后果。在肝酶异常发作时检测 HEV RNA。此外，在 alloHSCT 前后评估 HEV RNA 和 HEV 血清学。我们发现 8 例（2.4%）HEV 感染，其中 5 例发生慢性 HEV 感染。alloHSCT 前的血清流行率为 13%。4 例患者因 HEV 血症伴有持续肝炎表现而死亡，感染中位时间为 4.1 个月。4 例存活患者在中位 6.3 个月后清除了 HEV。1 例患者在 alloHSCT 前先前感染后被诊断为 HEV 再激活。尽管 alloHSCT 后发生急性 HEV 的发生率相对较低，但严重免疫功能低下患者发生慢性肝炎的可能性很高。因此，alloHSCT 受者应在移植前通过 HEV 血清学和 RNA 进行筛查。此外，所有发生严重肝酶异常的 alloHSCT 患者均需进行包括戊型肝炎在内的鉴别诊断。
