Co-infection and clinical impact of human herpesvirus 5 and 6 in liver transplantation.

Abstract

BACKGROUND:

Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction.

OBJECTIVE:

The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections.

METHODS:

Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection.

RESULTS:

IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5.

CONCLUSIONS:

HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.

• Authors: A M Sampaio, A C Guardia, A Milan, A N Sasaki, P D Andrade, S H A Bonon, R S B Stucchi, S C Botelho Costa, I F S F Boin
• Journal: Transplantation proceedings (Transplant Proc) Vol. 44 Issue 8 Pg. 2455-8 (Oct 2012) ISSN: 1873-2623 [Electronic] United States
• PMID: 23026619 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Viral

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Antibodies, Viral (blood)
• Bacterial Infections (diagnosis, etiology, immunology, microbiology)
• Biopsy
• Chi-Square Distribution
• Coinfection
• Cytomegalovirus (genetics, immunology, pathogenicity)
• Cytomegalovirus Infections (complications, diagnosis, immunology, virology)
• Graft Rejection (diagnosis, etiology, immunology, virology)
• Herpesvirus 6, Human (genetics, immunology, pathogenicity)
• Humans
• Liver Transplantation (adverse effects, immunology)
• Middle Aged
• Polymerase Chain Reaction
• Predictive Value of Tests
• Prospective Studies
• Risk Assessment
• Risk Factors
• Roseolovirus Infections (complications, diagnosis, immunology, virology)
• Time Factors
• Treatment Outcome
• Viral Load
• Virus Activation
• Virus Latency
• Young Adult