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Hepatitis E virus infection in hematopoietic stem cell transplant recipients: a systematic review and meta-analysis
  1. Angkawipa Trongtorsak1,
  2. Natapat Chaisidhivej2,
  3. Kritika Yadav1,
  4. Jinah Kim3,
  5. Charat Thongprayoon4,
  6. Wisit Cheungpasitporn4,
  7. Panupong Hansrivijit3
  1. 1 Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois, USA
  2. 2 Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
  3. 3 Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
  4. 4 Department of Medicine, Mayo Clinic, Rochester, New York, USA
  1. Correspondence to Dr Panupong Hansrivijit, Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA; hansrivijitp{at}


Although most patients with hepatitis E virus (HEV) infection are asymptomatic or have mild symptoms, its infection is generally underdiagnosed and overlooked. In immunocompromised patients, HEV infection can lead to acute liver failure and death. However, the clinical evidence of HEV infection in hematopoietic stem cell transplant (HSCT) recipients is scarce; thus, we conducted this systematic review and meta-analysis to assess the prevalence of HEV infection in this population. We searched MEDLINE, EMBASE, and the Cochrane Library databases from inception through October 2020 to identify studies that reported the prevalence of HEV infection among HSCT recipients. HEV infections were confirmed by HEV-IgG/IgM or HEV-RNA assay. A total of 1977 patients from nine studies with a follow-up time up to 40 months were included in the final analysis. The pooled prevalence of positive HEV-RNA was 3.0% (95% CI 2.3% to 4.0%). The pooled prevalence of positive HEV-IgG was 10.3% (95% CI 4.5% to 21.8%). The pooled prevalence of de novo HEV infection was 2.9% (95% CI 1.8% to 4.5%). Age and male gender were not associated with HEV-RNA or HEV-IgG positivity in the meta-regression analysis. In conclusion, the prevalence of HEV-IgG in HSCT recipients was about 10%, while the prevalence of HEV-RNA was only 3%. However, further studies that focus on the clinical outcomes in this population are warranted.

  • hepatitis
  • hematologic diseases
  • transplantation
  • autologous
  • medicine
  • evidence-based medicine

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  • Contributors PH and WC performed the systematic search. AT, JK, CT, and PH screened the citations. AT, NC, KY, JK, and PH extracted the data. AT and PH analyzed the data. AT, NC, KY, JK, and PH drafted the manuscript. AT, WC, CT, and PH revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.