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HEV infection in stem cell transplant recipients—retrospective study of EBMT Infectious Diseases Working Party

Bone Marrow Transplantation volume 57, pages 167–175 (2022)Cite this article

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Abstract

HEV infection is an emerging cause of acute and chronic hepatitis in stem cell transplant (SCT) recipients. We performed a retrospective observational study among EBMT centers with the aim of describing characteristics, management and outcome of HEV after SCT. There were 34 cases of HEV infection from 12 centers in 6 countries, diagnosed in median 4.5 months after SCT; 20 of acute and 14 of chronic infection. Non-hepatic findings possibly associated with HEV infection were present in 9 (26%). Patients with chronic infection had more characteristics associated with severely immunocompromised status. Ribavirin was provided to 16 patients (47%; 40% with acute and 57% with chronic infection), in median for 75 days. Three (19%) patients discontinued it due to side effects. HEV-RNA clearance occurred in 29 patients (85%; 85% in acute and 86% in chronic infection). HEV was considered a cause of death in 3 (9%), with 2 cases with late diagnosis. Reduction of immunosuppression in those receiving it, and ribavirin treatment in those with chronic infection were associated with shorter time to HEV-RNA clearance. Policy on HEV testing varied between the centers. In conclusion, acute and chronic HEV hepatitis should be promptly diagnosed and managed in SCT recipients.

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Fig. 1: Management and outcome of patients diagnosed with acute and chronic HEV infection.

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Author information

Authors and Affiliations

  1. Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Malgorzata Mikulska

  2. Department of Department of Hematology, Oncology and Tumorimmunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Olaf Penack

  3. EBMT Data Office, Dept. Medical Statistics & Bioinformatics, Leiden, The Netherlands

    Lotus Wendel & Nina Knelange

  4. Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands

    Jan J. Cornelissen

  5. Radboud University Medical Center, Nijmegen, The Netherlands

    Nicole Blijlevens

  6. University Hospital, Hematology, Basel, Switzerland

    Jakob Passweg

  7. Department of Stem cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Nicolaus Kroger

  8. Department of Hematology, University Medical Centre, Utrecht, Netherlands

    Anke Bruns

  9. Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany

    Christian Koenecke

  10. Princess Maxima Center/University Hospital for Children (WKZ) Stem cell transplantation, Utrecht, Netherlands

    Marc Bierings

  11. Hospital Clínico Universatario of Valencia, INCLIVA foundation, Valencia, Spain

    José Luis Piñana

  12. Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France

    Helene Labussiere-Wallet

  13. Department Haematology, Hospices Civils de Lyon, Pierre Benite, France

    Herve Ghesquieres

  14. Nino Jesus Children’s Hospital, Madrid, Spain

    Miguel Angel Diaz

  15. Hospital Universitari Son Espases, Palma, Spain

    Antonia Sampol

  16. Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem; Hadassah Medical Center, Jerusalem, Israel

    Diana Averbuch

  17. Department of Hematology, Hospital de la Princesa, Madrid, Spain

    Rafael de la Camara

  18. Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland

    Jan Styczynski

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  1. Malgorzata Mikulska
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Contributions

Conceptualization and design: MM, O.P., JS; collection and assembly of data: LW, NK; Data analysis: MM, O.P., DA; Provision of patients, data interpretation: MM, JJC, NB, JP, NK, AB, CK, MB, JLP, HLW, HG, MAD, AS, DA, RC, J.S. Manuscript writing: MM. All the authors have read and approved the published version of the manuscript.

Corresponding author

Correspondence to Malgorzata Mikulska.

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Competing interests

OP has no conflict of interests directly related to this manuscript. He has received honoraria or travel support from Astellas, Gilead, Jazz, MSD, Neovii Biotech, Novartis, Pfizer and Therakos. He has received research support from Gilead, Incyte, Jazz, Neovii Biotech and Takeda. He is member of advisory boards to Jazz, Gilead, MSD, Omeros, Priothera, Shionogi and SOBI. All other authors: nothing to declare.

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Mikulska, M., Penack, O., Wendel, L. et al. HEV infection in stem cell transplant recipients—retrospective study of EBMT Infectious Diseases Working Party. Bone Marrow Transplant 57, 167–175 (2022). https://doi.org/10.1038/s41409-021-01497-2

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