Genotype 3 and 4 hepatitis E virus (HEV) infections are prevalent in developed countries and can cause chronic hepatitis, cirrhosis, and extra-hepatic manifestations among solid-organ-transplant (SOT) patients. In developed countries, the main source of transmission is via consumption of raw or undercooked infected meat, or direct contact with infected animals. The prevalence of HEV RNA among blood donors ranges from 1/1,200 to 1/1,14,000 in different countries. Cases of blood-transmitted hepatitis E have also been reported. Hence, transfusion-transmitted infection of SOT patients remains a major concern.

We investigated retrospectively the extent to which transfusion-transmitted HEV infection occurred in a cohort of 60 SOT patients infected with HEV. We found that 7 of the 60 SOT patients infected with HEV (11.7%) were given a transfusion in the 6 months preceding a diagnosis. The median HEV RNA concentration was 5.4 log copies/mL (range: 3.6–6.8). A total of 231 blood-donor samples were linked to the 7 patients whose HEV infection was suspected to be transfusion-transmitted. Samples were tested individually. Of these, 7/231 (3.0%) tested positive for HEV RNA. The median HEV RNA dose given to recipients was 5.1 log copies (range: 3.8–8.4). Four patients were not given viremic donations. By contrast, 3 patients received one or more blood components derived from the 7 HEV RNA-positive donations. Phylogenic analyses of the 348nt partial sequences of the ORF2 region showed that, in two cases, donor/recipient sequences clustered together; nucleotides were >99.0% identical in both cases, supporting transfusion-transmitted HEV infection. In the last case, donor/recipient data also clustered together, but sequence identity was only 84.2%. Hence, transfusion-transmitted infection was confirmed by phylogenetic analyses in 2 patients and was possible in one other.

We conclude that, although transfusion-transmitted HEV infection can occur in SOT patients, the risk of transfusion-transmitted HEV infection is lower than that related to environmental factors in this population.

CITATION INFORMATION: Kamar N, Lhomme S, Abravanel F, Esposito L, Hebral A, Marion O, Del Bello A, Izopet J. Risk Factor for Hepatitis E Virus Infection Among Solid-Organ-Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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