Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018

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.