@article {4800,
	title = {Unique clinical courses of transfusion-transmitted hepatitis E in patients with immunosuppression},
	volume = {57},
	year = {2017},
	month = {Feb},
	abstract = {BACKGROUND:  The high prevalence of specific immunoglobulin G for hepatitis E virus (HEV) in Japanese people raises the possibility of a high incidence of HEV-viremic blood donors and therefore frequent transfusion-transmitted HEV (TT-HEV). STUDY DESIGN AND METHODS:  TT-HEV cases established in Japan through hemovigilance and those published in the literature were collected. Infectivity of HEV-contaminated blood components and disease severity in relation to immunosuppression were investigated. RESULTS:  Twenty established TT-HEV cases were recorded over the past 17 years. A lookback study verified that five of 10 patients transfused with known HEV-contaminated blood components acquired HEV infection. The minimal infectious dose of HEV through transfusion was 3.6 {\texttimes} 104 IU. Nine of the 19 TT-HEV cases analyzed had hematologic diseases. Only two cases showed the maximal alanine aminotransferase level of more than 1000 U/L. Two patients with hematologic malignancy and two liver transplant recipients had chronic liver injury of moderate severity. CONCLUSION:  The infectivity of HEV-contaminated components was 50\%. Immunosuppression likely causes the moderate illness of TT-HEV, but it may lead to the establishment of chronic sequelae. Transfusion recipients, a population that is variably immunosuppressed, are more vulnerable to chronic liver injury as a result of TT-HEV than the general population is as a result of food-borne infection.},
	doi = {10.1111/trf.13994},
	author = {Satake, M and Matsubayashi, K and Hoshi, Y and Taira, R and Furui, Y and Kokudo, N and Akamatsu, N and Yoshizumi, T and Ohkohchi, N and Okamoto, H and Miyoshi, M and Tamura, A and Fuse, K and Tadokoro, K}
}
