Hepatitis E is an acute and chronic infectious disease caused by hepatitis E virus infection, which is a significant public health concern worldwide. Although hepatitis E is generally considered an asymptomatic, self-limiting disease, its clinical manifestations vary, some individuals may develop severe or chronic progression, resulting in poor prognosis and serious harm. Immune response is a key factor determining the clinical manifestation and outcome of hepatitis E. Normal immune response helps virus clearance and recovery of this disease, while excessive or disordered immune response can lead to disease progression and participate in the severe and chronic progression of the disease. Through literature review, this article summarizes the immunological mechanisms of HEV related liver failure and chronic hepatitis E, including innate immune response and adaptive immune response, in order to provide theoretical basis and new ideas for early prediction and prevention, treatment and management of this disease.