CD40LG and Decreased liver function: HEV infection in immunosuppressed patients is often characterized by mild aminotransferase elevation or lack of typical hepatitis symptoms, which is easily masked by the primary disease, leading to delayed diagnosis.[34] Therefore, timely detection of HEV-RNA (serum or fecal) and anti-HEV-IgM/IgG is recommended for immunosuppressed patients with unexplained liver dysfunction or thrombocytopenia.