Transfusion-transmitted hepatitis E: What we know so far?

Table 4 Reported cases of transfusion transmitted hepatitis E

Study	Number of patients	Comorbidity	Blood component received (n)	Viral load of transfused blood product IU/mL	Genotype	Treatment	Outcome
Okano et al[137], 2020	1	AML on chemotherapy	Plt	N/A	3b	Nil	Spontaneous resolution and developed HEV antibodies after cessation of chemotherapy for AML
Gallian et al[138], 2019	23	Solid organ transplant, n = 9; allogeneic hematopoietic stem cells transplant, n = 4; hematologic malignancies, n = 5; immunosuppressant, n = 2; immunocompetent, n = 3	RBC n = 7; apheresis Plt n = 3; whole blood-derived pooled Plt n = 6; FFP n = 7	Ranged from 1.14 × 103 to 31 × 62.106	3a, n = 1; 3c, n = 4; 3f, n = 16; 3, n = 1; 4d, n = 1	Ribavirin, n = 15	Acute HEV infection, n = 8; spontaneous resolution, n = 4; ribavirin treatment, n = 3; immunosuppressant reduction, n = 1; chronic HEV infection, n = 14, all immunosuppressed; resolution with ribavirin, n = 10; resolution with immunosuppressant reduction, n = 4; One solid organ transplant recipient did not clear HEV infection despite ribavirin and died of multiorgan failure
Ledesma et al[139], 2019	2	Allogeneic BMT, n = 1; liver transplant, n = 1	Plt	3 × 104	3e	Ribavirin, n = 1	The patient received BMT remained HEV-infected and IgM/IgG-negative until death; the patient with liver transplant was treated successfully with a course of ribavirin
Satake et al[140]a, 2017	19	Hematologic malignancies, n = 6; organ transplant, n = 2; systemic disease, n = 8; no major comorbidity, n = 3	RBC n = 10; Plt n = 6; FFP n = 3	Ranged from 1.5 × 102 to 5.3 × 106	4, n = 2	N/A	Two patients with malignant lymphoma and two who had received liver transplant developed chronic hepatitis E; the two liver transplant recipients were successfully cleared of HEV by ribavirin
Lhomme et al[141], 2017	3	Solid organ transplant	One patient received RBC; one patient received RBC and Plt; one patient received Plt and FFP	Ranged from 3.6 to 8.2 log IU	3, n = 1; 3f, n = 2	N/A	N/A
Yamazaki et al[142], 2017	2	Hematologic malignancies treated with chemotherapy	N/A	N/A	3b	N/A	Did not become chronic hepatitis E
Belliere et al[143], 2017	1	Heart transplant	RBC	1430 copies/mL	3	Ribavirin	Died from multi-organ failure despite treatment
Riveiro-Barciela et al[144], 2017	1	Immunocompetent, admitted for disseminated infection	RBC	75000	3	Nil	Spontaneous resolution
Hoad et al[145], 2017	1	Liver transplant	FFP	947	3	Ribavirin	Resolved with treatment
Matsui et al[146], 2015	1	AMI post CABG with hemorrhagic cardiac tamponade	Plt	106.8 copies	3	Nil	Spontaneous resolution
Huzly et al[147], 2013	1	Immunocompromised	Apheresis Plt	30888-37273	3f	N/A	N/A
Coilly et al[148], 2013	1	Liver transplant	RBC	3.5 log10	3c	Ribavirin	Resolved with treatment
Boxall et al[149], 2006	1	Lymphoma on chemotherapy	RBC	N/A	3	Nil	Spontaneous resolution
Mitsui et al[150], 2004	1	Hemodialysis	RBC	N/A	3	Nil	Subclinical infection without elevated ALT

^aTwo cases were not confirmed by sequence identity and should only be considered as probable TT-HEV.

ALT: Alanine aminotransferase; AMI: Acute myocardial infarction; AML: Acute myeloid leukemia; BMT: Bone marrow transplant; CABG: Coronary artery bypass graft; FFP: Fresh-frozen plasma; HEV: Hepatitis E virus; Ig: Immunoglobulin; Plt: Platelet concentrates; RBC: Red blood cell.