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Hepatitis E virus infection in a hematopoietic stem cell donor

Bone Marrow Transplantation volume 49, pages 159–160 (2014)Cite this article

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Hepatitis E virus (HEV) is an important cause of viral hepatitis, especially in immunocompromised patients.1 Versluis et al.2 recently studied the incidence and course of HEV-infection in a large cohort of patients undergoing allogeneic hematopoietic SCT (HSCT). In contrast to previously published studies from our group3 and others,4 they identified a considerable number of patients with chronic HEV infection with a significant lethality. Therefore, they suggested pretransplant HEV screening for HSCT recipients. Reconsidering these important new results we now even extend our position, strongly suggesting HEV screening in HSCT.

Although the incidence of HEV in Germany is low5 and the donor did not belong to a risk population with a recent history of travel to countries endemic for HEV or contact with deer or pigs, we tested for HEV. Hepatitis E was diagnosed by positive results on anti-HEV-IgM and HEV-RNA detection (as described previously6). The donor’s HEV infection was diagnosed immediately before transplantation of the contagious allogeneic stem cells. Owing to the reported high lethality of HEV infection after HSCT and uncertain therapeutic options,1, 7 we decided not to transplant the contaminated graft. Instead, as an escape strategy for the patient in BM aplasia after myeloablative conditioning, we decided to use autologous stem cells from the patient which had been stored earlier for high-dose therapy. The patient showed neutrophil recovery 10 days after autologous transplantation and is planed in case of further progress for a second attempt at sibling HSCT when his brother has overcome the HEV infection. Of note, when testing the donor’s serum from pretransplant screening 2 weeks before stem cell donation, we were able to retrospectively detect HEV-RNA. At that time, mandatory laboratory tests such as liver enzymes and bilirubin were normal (alanine aminotransferase, 41 U/L) or only slightly elevated (aspartate aminotransferase 50 U/L; γ-glutamyltransferase 73 U/L; bilirubin 29 μmol/L). This implies that the HEV infection could have been diagnosed before donor clearance and start of the patient’s conditioning therapy.

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Acknowledgements

We are very grateful to Albert Heim for providing serum samples and Birgit Bremer for technical assistance (both Hannover Medical School).

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Authors and Affiliations

  1. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany

    C Koenecke, G Beutel, U Ritter, A Ganser & M Eder

  2. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

    S Pischke & H Wedemeyer

Authors
  1. C Koenecke
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  2. S Pischke
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  3. G Beutel
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  4. U Ritter
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  5. A Ganser
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  6. H Wedemeyer
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  7. M Eder
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Correspondence to C Koenecke.

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All authors were involved in treatment of the patient. All authors analyzed and discussed the data. CK wrote the manuscript.

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Koenecke, C., Pischke, S., Beutel, G. et al. Hepatitis E virus infection in a hematopoietic stem cell donor. Bone Marrow Transplant 49, 159–160 (2014). https://doi.org/10.1038/bmt.2013.148

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