218 www.thelancet.com Vol 383 January 18, 2014 4 Coilly A, Haim-Boukobza S, Roche B, et al. Posttransplantation hepatitis E: transfusiontransmitted hepatitis rising from the ashes. Transplantation 2013; 96: e4–6. 5 Zhu FC, Zhang J, Zhang XF, et al. Effi cacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 2010; 376: 895–902. Since 2012, five cases of chronic hepatitis E transmitted through blood transfusions were diagnosed (out of 367 transplantations) in the Paul Brousse Centre (Villejuif, France) and Creteil liver transplant centre (Creteil, France). Treatment of chronic hepatitis E infection in liver transplant recipients is decreasing immunosuppression and ribavirin. In these patients, eradication of hepatitis E is not always obtained by antiviral drugs, and substantial liver damage might persist, even after viral clearance. Transfusion of blood products not screened for hepatitis E is associated with a risk of chronic hepatitis E infection in immunocompromised patients. Two recombinant hepatitis E vaccines have successfully gone through phase 3 trials, but they are not yet available and their effi cacy on hepatitis E genotype 3 is unknown. In view of the prevalence of hepatitis E infection in the general population (and therefore in potential blood donors) and the severe consequences of hepatitis E infection in immunocompromised patients, we believe that systematic screening of blood products for markers of hepatitis E infection should be implemented in countries where hepatitis E is endemic, including Germany, Sweden, and France. Because serological testing is poorly sensitive, hepatitis E nucleic acid testing should be considered.