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Hepatitis E virus is an infrequent but potentially serious infection in allogeneic hematopoietic stem cell transplant recipients

Artikel i vetenskaplig tidskrift
Författare L. Swartling
Rickard Nordén
Ebba Samuelsson
K. Boriskina
D. Valentini
Johan Westin
Helene Norder
E. Sparrelid
P. Ljungman
Publicerad i Bone Marrow Transplantation
ISSN 0268-3369
Publiceringsår 2020
Publicerad vid Institutionen för biomedicin, avdelningen för infektionssjukdomar
Språk en
Länkar dx.doi.org/10.1038/s41409-020-0823-...
Ämnesord versus-host-disease, donor, Biophysics, Oncology, Hematology, Immunology, Transplantation
Ämneskategorier Infektionsmedicin, Cancer och onkologi, Immunologi inom det medicinska området, Hematologi

Sammanfattning

Hepatitis E virus (HEV) can cause chronic infection and liver cirrhosis in immunocompromised individuals. The frequency and clinical importance of HEV was studied retrospectively in a cohort of 236 Swedish allogeneic hematopoietic stem cell transplantation (HSCT) recipients. In blood samples collected at 6 months after HSCT, HEV RNA was identified in 8/236 (3.4%) patients, and 11/236 (4.7%) patients had detectable anti-HEV IgG and/or IgM, eight of whom were HEV RNA negative. Two of the patients with positive HEV RNA died with ongoing signs of hepatitis: one of acute liver and multiple organ failure, the other of unrelated causes. The remaining six patients with HEV RNA had cleared the infection at 7-24 (median 8.5) months after HSCT. HEV infection was associated with elevated alanine aminotransferase at 6 months after HSCT (OR 15, 1.3-174, p = 0.03). Active graft-versus-host disease of the liver at 6 months after HSCT was present in 3/8 (38%) patients with HEV RNA, but was not significantly associated with HEV infection. In conclusion, HEV infection is an important differential diagnosis in patients with elevated liver enzymes after HSCT. Although spontaneous clearance was common, the clinical course may be severe.

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