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Fatal autochthonous fulminant hepatitis E early after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 643–645 (2017)Cite this article

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For decades, hepatitis E virus (HEV) genotypes 1 and 2, transmitted via the fecal–oral route, have been known to be responsible for waterborne outbreaks of infection in developing countries. In recent years, HEV genotypes 3 and 4 have been found to be endemic in developed countries, causing sporadic autochthonous zoonotic infections, mostly by the consumption of raw or undercooked pork, wild boar or deer.1 In immunocompetent individuals, HEV infection is most of the time asymptomatic or presents as acute non-severe self-limiting hepatitis, except in pregnant women and in patients with underlying chronic liver disease who can develop acute fulminant hepatitis.2 Conversely, in immunocompromised patients such as solid organ transplant (SOT) recipients,3 patients suffering from hematological malignancies treated by chemotherapy and/or stem cell transplantation4 and more rarely from HIV, HEV infections have been reported to cause chronic hepatitis rapidly leading to cirrhosis. We note that reports of acute hepatitis in such patients are rare, including in patients who have undergone allogeneic stem cell transplantation (allo-HSCT).5

A first series of hepatitis E in immunocompromised patients was reported in kidney and liver transplant recipients3 followed by numerous reports in various types of SOT. No acute severe form has been reported but chronic evolution was the major complication. Concerning allo-HSCT, the largest cohort was 328 patients with a reported incidence rate of acute HEV of 2.4% and a risk of developing chronic hepatitis of 63%.4 Nevertheless, two other studies based on much smaller series of patients reported a low risk of chronic HEV infection.6, 7 Notably, none of the recipients experienced acute severe hepatitis. Pfefferl et al.5 reported the only case of HEV-induced fatal acute liver failure in a patient with chronic kidney disease requiring hemodialysis, long after an allo-HSCT but only several weeks after donor lymphocyte and Rituximab infusions.

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Acknowledgements

We thank Dr Alison Foote (Grenoble Alpes University Hospital) for language editing and Francis Meyer (Etablissement Français du Sang Rhone Alpes Auvergne) for blood products HEV testing.

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Authors and Affiliations

  1. Clinique Universitaire d’Hématologie, CHU de Grenoble Alpes, La Tronche, France

    M Carré, A Thiebaut-Bertrand, J-Y Cahn & F Garban

  2. Laboratoire de Virologie, Institut de Biologie Structurale (UMR 5075), Univ. Grenoble Alpes, CEA, CNRS, Grenoble, France

    S Larrat & P Morand

  3. Clinique Universitaire d’Hépato-gastro-entérologie, CHU de Grenoble Alpes, La Tronche, France

    V Leroy

  4. Unité d’hémovigilance et sécurité transfusionnelle, pôle de santé publique, CHU de Grenoble Alpes, La Tronche, France

    P Pouzol

  5. Département d'Anatomie et de Cytologie Pathologiques, pôle de Biologie CHU de Grenoble Alpes, La Tronche, France

    N Sturm

  6. INSERM UMR 1043/CNRS UMR 5282, Université Toulouse III, National Reference Center HEV, CHU Toulouse, Toulouse, France

    S Lhomme

  7. UMR CNRS 5525 équipe THEREX Université de Grenoble Alpes, Grenoble, France

    J-Y Cahn & F Garban

  8. Etablissement Français du Sang, site de Grenoble,, La Tronche, France

    F Garban

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  1. M Carré
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Correspondence to M Carré.

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Carré, M., Thiebaut-Bertrand, A., Larrat, S. et al. Fatal autochthonous fulminant hepatitis E early after allogeneic stem cell transplantation. Bone Marrow Transplant 52, 643–645 (2017). https://doi.org/10.1038/bmt.2016.337

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