Herpes simplex virus (HSV)
hepatitis has a fatal impact on the outcome of organ transplanted recipients. Here, we present a thought-provoking case of HSV
hepatitis in a high-risk recipient after living-related
liver transplantation (LRLT). A 1-month-old female newborn infant was affected by HSV
encephalitis.
Fulminant hepatic failure (FHF) of unknown etiology occurred suddenly at 4.4 years of age.
Viral infections were ruled out as the cause of FHF.
Intensive care including
plasma exchange (PE) was started, and the preoperative treatments for ABO incompatibility were performed. Thereafter, LRLT was performed emergently. Although strong immunosuppression for ABO incompatibility was continued after LRLT, antibody-mediated rejection (AMR) occurred on postoperative day (POD) 4. PE was repeated and improvements were obtained. However,
liver dysfunction appeared on POD 8. Histopathological findings of liver needle biopsy clearly revealed HSV
hepatitis, although the results of HSV
DNA and antibody titer in blood sample did not clearly indicate HSV
infection. On POD 21,
thrombotic microangiopathy (TMA) occurred and the plasma and
immunoglobulin were replenished. Our pediatric recipient recovered successfully from AMR, HSV
hepatitis, TMA, and repeated
sepsis. We conclude that well considered
therapy based on the real-time detection of HSV
hepatitis is indispensable for the further improvements of outcome in HSV
hepatitis after LRLT.