TY - JOUR T1 - Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018 Y1 - 2019 A1 - Sridhar, S A1 - Cheng, Vincent CC A1 - Wong, SC A1 - Yip, Cyril CY A1 - Wu, S A1 - Lo, Anthony WI A1 - Leung, KH A1 - Mak, Winger WN A1 - Cai, J A1 - Li, X A1 - Chan, Jasper FW A1 - Lau, Susanna KP A1 - Woo, Patrick CY A1 - Lai, WM A1 - Kwan, TH A1 - Au, Timmy WK A1 - Lo, CM A1 - Wong, Sally CY A1 - Yuen, KY AB - Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients. VL - 25 CP - 3 ID - 4750 ER -