Hepatitis E Virus Infection after Haploidentical Hematopoietic Stem Cell Transplantation:Incidence and Clinical Course

Introduction: Hepatitis E virus (HEV) is increasingly found to cause hepatitis in allogeneic hematopoietic stem cell transplantation (HSCT) patients. However, little is known about HEV infection in patients treated with haploidentical HSCT (haplo-HSCT). Here, we retrospectively evaluate the incidence and clinical course of HEV infection in haplo-HSCT patients. Methods: From January 2014 to July 2017, 177 patients with unexplained elevated transaminases after receiving haplo-HSCT at Peking University Institute of Haematology were screened for HEV infection using HEV serology. HEV RNA were performed when HEV-IgG and/or IgM antibodies were positive. Results: Acute HEV infection was identified in seven of these patients (3.9%), none of whom had developed a chronic HEV infection. The median time from haplo-HSCT to HEV infection was 17.5 (range, 6-55) months. Median peak alanine transaminase during HEV infection was 716 (range, 164-1763) U/L. In 7 cases, HEV infection was confirmed by the presentation of anti-HEV IgM + anti-HEV IgG (rising) (n=5) or HEV-RNA + anti-HEV IgM + anti-HEV IgG (n=2). None patients died of HEV infection directly. Two patients with HEV infection died showing signs of ongoing hepatitis and the median duration of HEV infection was 2.7 months. Five patients cleared HEV and the median duration of HEV infection was 1.5 (range, 1.0-5.7) months. Conclusions: In conclusion, HEV infection is a rare but serious complication after haplo-HSCT. We recommend screening of HEV infection in haplo-HSCT. Disclosures No relevant conflicts of interest to declare.