Transfusion

BACKGROUND:Hepatitis E virus (HEV) can inapparently infect blood donors. To assess transfusion transmission of HEV in the United States, which has not been documented, a donor-recipient repository was evaluated.STUDY DESIGN AND METHODS:To identify donations that contained HEV RNA and were linked to patient-recipients with antibody evidence of HEV exposure, we assayed samples from the Retrovirus Epidemiology Donor Study (REDS) Allogeneic Donor and Recipient repository that represents 13,201 linked donations and 3384 transfused patients. Post-transfusion samples, determined to contain IgG anti-HEV by ELISA, were re-assayed along with corresponding pre-transfusion samples for seroconversion (incident exposure) or 654-fold IgG anti-HEV increase (re-exposure). HEV-exposed patients were linked to donations in which HEV RNA was then detected by RT-qPCR, confirmed by Transcription Mediated Amplification (TMA), and phylogenetically analyzed as sub-genomic cDNA sequences.RESULTS:Among all patients, 19 of 1036 (1.8%) who had IgG anti-HEV before transfusion were re-exposed; 40 of 2348 (1.7%) without pre-transfusion IgG anti-HEV seroconverted. These 59 patients were linked to 257 donations, 1 of which was positive by RT-qPCR and TMA. Plasma from this donation contained 5.5 log10 IU/mL of HEV RNA that grouped with HEV genotype 3, clade 3abchij. The patient-recipient of pRBC from this donation had a >8-fold IgG increase; however, clinical data are unavailable.CONCLUSIONS:This is the first report of probable HEV transmission via transfusion in the US, although it has been frequently observed in Europe and Japan. Additional data on the magnitude of the risk in the US are needed.20192020-03-01T00:00:00ZK01 OH010193/OH/NIOSH CDC HHS/United StatesR01 ES026973/ES/NIEHS NIH HHS/United StatesR21 HL121740/HL/NHLBI NIH HHS/United States30702157PMC6501795731