Hepatitis E Virus (HEV)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
First described cases of hepatitis E virus (HEV) transmission from a common donor to two renal recipients.
Time to detection: 
9 - 11 months
Alerting signals, symptoms, evidence of occurrence: 
Progressive hepatic cytolysis, cholestasis, hepatosplenomegaly, chronic hepatitis.
Demonstration of imputability or root cause: 
Renal recipients: positive HEV RT-PCR (6.56 and 6.78 log IU/mL, respectively), HEV 3f genotype identified by sequence analysis of the open reading frame (ORF) 2 region, negative HEV IgG and IgM serology (recipient 1). Common donor: positive RT-PCR test for HEV (6.46 log IU/mL), positive serology (HEV IgG and IgM), HEV 3f genotype. Phylogenetic analysis revealed a 100% homology of sequences between the 3 HEV strains when comparing 2 ORF regions encoding the viral capsid protein and the RNA-dependent RNA polymerase. Both recipients received antiviral therapy (ribavirin) and currently are HEV RNA negative. No other organs from the same donor were transplanted.
Imputability grade: 
3 Definite/Certain/Proven
Suggest new keywords: 
Progressive hepatic; cytolysis; cholestasis; hepatosplenomegaly; chronic hepatitis
renal transplant
kidney transplant
genotype 3
HEV; hepatitis E virus
Reference attachment: 
Suggest references: 
Evidence of hepatitis E virus transmission by renal graft. Pourbaix et al. Transpl Infect Dis. 2016 Oct 24. doi: 10.1111/tid.12624. [Epub ahead of print]
Expert comments for publication: 
Although transfusion-associated HEV transmission is well described, as of May 2017, only 3 cases of solid organ transplant-associated transmission of HEV have been published. Frequency of this event will depend on incidence and prevalence of HEV in local donor and recipeint populations, with the dietary route accounting for the vast majority of infections in the general population. Awareness of HEV as a cause of persistent hepatitis in the immunocompromised host is improving.