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Adverse Occurrence type:
First report of HEV transmission via an infected organ from a donor with occult HEV infection leading to chronic HEV infection in a liver transplant recipient. This is the only publication in the English language to date, describing donor-derived HEV transmission in solid organ transplantation.
Time to detection:
37 - 150 days
Alerting signals, symptoms, evidence of occurrence:
Elevated levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase. Anti-HEV IgG, IgM, and HEV RNA were detected in the first tested serum sample of the liver recipient obtained 150 days after orthotopic liver transplantation (OLT) and remained positive (serology and HEV RNA were negative in samples obtained before OLT, earlier samples after OLT were not available). Liver cirrhosis developed within 15 months and the patient died of septic shock.
Demonstration of imputability or root cause:
Retrospectively examined donor serum was negative for HEV antibodies and RNA, but liver tissue of the donor taken at point of explantation was positive for HEV RNA. Phylogenetic analysis of the donor and recipient’s HEV strains from liver tissue and serum respectively, revealed HEV genotype 3 identical sequences. Authors discuss the lower limit of detection of the PCR assay used (2000 copies/ml) s a possible explanation for the undetectable HEV plasma RNA in the donor and the unlikely possibility of contamination leading to the positive PCR result in the liver tissue.
Suggest new keywords:
Schlosser B, Stein A, Neuhaus R, Pahl S, Ramez B, Kruger DH, et al. Liver transplant from a donor with occult HEV infection induced chronic hepatitis and cirrhosis in the recipient. Journal of hepatology. 2012;56(2):500-2.
Expert comments for publication:
The entity of occult HEV (negative serological and molecular markers in plasma or serum with positive fiding in liver tissue) has not been described elsewhere.