Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018

Emerg Infect Dis. 2019 Mar;25(3):425-433. doi: 10.3201/eid2503.181563.


Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.

Keywords: China; Hong Kong; chronic hepatitis; hepatitis; hepatitis E; hepatitis E virus; immune system; ribavirin; transplantation; viruses.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Child
  • Disease Outbreaks
  • Female
  • Genotype*
  • Hepatitis E / diagnosis
  • Hepatitis E / epidemiology*
  • Hepatitis E / history
  • Hepatitis E / virology*
  • Hepatitis E virus / classification
  • Hepatitis E virus / genetics*
  • History, 21st Century
  • Hong Kong / epidemiology
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Molecular Typing
  • Organ Transplantation
  • Phylogeny
  • Sequence Analysis, DNA
  • Serologic Tests
  • Tissue Donors*