Unique clinical courses of transfusion-transmitted hepatitis E in patients with immunosuppression

Masahiro Satake, Keiji Matsubayashi, Yuji Hoshi, Rikizo Taira, Yasumi Furui, Norihiro Kokudo, Nobuhisa Akamatsu, Tomoharu Yoshizumi, Nobuhiro Ohkohchi, Hiroaki Okamoto, Masato Miyoshi, Akinori Tamura, Kyoko Fuse, Kenji Tadokoro

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)


BACKGROUND: The high prevalence of specific immunoglobulin G for hepatitis E virus (HEV) in Japanese people raises the possibility of a high incidence of HEV-viremic blood donors and therefore frequent transfusion-transmitted HEV (TT-HEV). STUDY DESIGN AND METHODS: TT-HEV cases established in Japan through hemovigilance and those published in the literature were collected. Infectivity of HEV-contaminated blood components and disease severity in relation to immunosuppression were investigated. RESULTS: Twenty established TT-HEV cases were recorded over the past 17 years. A lookback study verified that five of 10 patients transfused with known HEV-contaminated blood components acquired HEV infection. The minimal infectious dose of HEV through transfusion was 3.6 × 104 IU. Nine of the 19 TT-HEV cases analyzed had hematologic diseases. Only two cases showed the maximal alanine aminotransferase level of more than 1000 U/L. Two patients with hematologic malignancy and two liver transplant recipients had chronic liver injury of moderate severity. CONCLUSION: The infectivity of HEV-contaminated components was 50%. Immunosuppression likely causes the moderate illness of TT-HEV, but it may lead to the establishment of chronic sequelae. Transfusion recipients, a population that is variably immunosuppressed, are more vulnerable to chronic liver injury as a result of TT-HEV than the general population is as a result of food-borne infection.

Original languageEnglish
Pages (from-to)280-288
Number of pages9
Issue number2
Publication statusPublished - Feb 1 2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Hematology


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