Chronic hepatitis E virus (HEV) infection in hematopoietic stem cell transplant (HSCT) recipients is an emerging threat. The aim of this study was to provide data on HEV burden in an Italian cohort of HSCT recipients and analyze risk factors for HEV seropositivity.
This retrospective study reports data from 596 HSCT recipients from years 2010-2019. It included patients transplanted in years 2010-2015 for whom pre- (n=419) and post-transplant (n=161) serum samples were available and tested retrospectively; and patients in whom prospective HEV testing was performed during the standard care: pre-HSCT IgG screening in 144, pre-HSCT HEV-RNA screening in addition to IgG screening in 60 and HEV-RNA testing in case of clinical suspicion of HEV infection in 59 (26 of them included also in the IgG screening cohorts).
Pre-HSCT HEV-IgG positivity was 6.0% (34/563). Independent risk factor for seropositivity was older age (p=0.039). None of 34 HEV-IgG positive patients had detectable HEV-RNA. One case of transient HEV-RNA positivity pre-HSCT was identified through screening. Two patients were diagnosed with chronic HEV hepatitis, and one was successfully treated with ribavirin.
The burden of HEV infection in HSCT recipients in Italy is limited and pre-HSCT screening seems of n benefit. Timely diagnosis of HEV infection with HEV-RNA is mandatory in case of clinical suspicion.

Copyright © 2020. Published by Elsevier Inc.