van der Eijk Annemiek A, Pas Suzan D, Cornelissen Jan J, de Man Robert A
aDepartment of Viroscience bDepartment of Hematology cDepartment of Hepatogastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands.
Curr Opin Infect Dis. 2014 Aug;27(4):309-15. doi: 10.1097/QCO.0000000000000076.
Recipients of allogeneic stem cell transplantations are at risk of acquiring acute hepatitis E virus (HEV) infection, leading to chronicity. We review the incidence, sequela, extrahepatic manifestations, and treatment of hepatitis due to HEV infection in allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients.
HEV infection and progression to chronic HEV in alloHSCT recipients are recently described. Misdiagnosis of HEV in alloHSCT recipients occurs, with liver enzyme abnormalities often attributed to hepatic graft-versus-host disease or drug-induced liver injury. HEV infection may occur in HSCT donors and emphasizes the need for HEV screening not only after HSCT, but also in donors presenting with liver function disturbances. The discussion about HEV screening of blood products will continue. Extrahepatic manifestations of hepatitis E are described.
HEV RNA screening in alloHSCT recipients with elevated liver enzymes is advised. Intervention strategies should be considered in cases of acute or chronic HEV infection. The first-line approach includes reduction of immunosuppressive medication. Oral ribavirin is in experienced hands a reasonable well tolerated treatment option, although the optimal dose, duration, and quantitative goals of ribavirin treatment are still unknown. Further studies are needed to improve our understanding of HEV, including extrahepatic manifestations and evaluation of therapeutic options.
异基因干细胞移植受者有感染急性戊型肝炎病毒（HEV）并导致慢性化的风险。我们综述了异基因造血干细胞移植（alloHSCT）受者中HEV感染所致肝炎的发病率、后遗症、肝外表现及治疗。
近期描述了alloHSCT受者中的HEV感染及进展为慢性HEV的情况。alloHSCT受者中存在HEV误诊现象，肝酶异常常归因于肝移植物抗宿主病或药物性肝损伤。HEV感染可能发生在HSCT供者中，这强调不仅在HSCT后，而且在出现肝功能障碍的供者中都需要进行HEV筛查。关于血液制品HEV筛查的讨论将继续。描述了戊型肝炎的肝外表现。
建议对肝酶升高的alloHSCT受者进行HEV RNA筛查。对于急性或慢性HEV感染病例应考虑干预策略。一线方法包括减少免疫抑制药物用量。口服利巴韦林在有经验的医生手中是一种耐受性较好的合理治疗选择，尽管利巴韦林治疗的最佳剂量、疗程和定量目标仍不清楚。需要进一步研究以增进我们对HEV的了解，包括肝外表现及治疗选择的评估。
