Simultaneous monitoring of CMV and human herpesvirus 6 infections and diseases in liver transplant patients: one-year follow-up

Abstract

OBJECTIVE:The aim of this study was to simultaneously monitoring cytomegalovirus and human herpesvirus 6 active infections using nested-polymerase chain reaction and, together with clinical findings, follow the clinical status of patients undergoing liver transplant.INTRODUCTION:The human β-herpesviruses, including cytomegalovirus and human herpesvirus 6, are ubiquitous among human populations. Active infections of human herpesvirus 6 and cytomegalovirus are common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy. Both viruses affect the success of the transplant procedure.METHODS:Thirty patients submitted to liver transplant at the Liver Transplant Unit, at the Gastro Center, State University of Campinas, SP, Brazil, were studied prospectively from six months to one year, nested-polymerase chain reaction for cytomegalovirus and human herpesvirus 6 DNA detections. Two or more consecutive positive nested-polymerase chain reaction were considered indicative of active infection.RESULTS:Active infection by cytomegalovirus was detected in 13/30 (43.3%) patients, median time to first cytomegalovirus detection was 29 days after transplantation (range: 0-99 days). Active infection by human herpesvirus 6 was detected in 12/30 (40%) patients, median time to first human herpesvirus 6 detection was 23.5 days after transplantation (range: 0-273 days). The time-related appearance of each virus was not statistically different (p = 0.49). Rejection of the transplanted liver was observed in 16.7% (5/30) of the patients. The present analysis showed that human herpesvirus 6 and/or cytomegalovirus active infections were frequent in liver transplant recipients at our center.CONCLUSIONS:Few patients remain free of betaherpesviruses after liver transplantation. Most patients presenting active infection with more than one virus were infected sequentially and not concurrently. Nested-polymerase chain reaction can be considered of limited value for clinically monitoring cytomegalovirus and human herpesvirus 6.

Cytomegalovirus Infection in Liver Transplantation

“…Detection of N-PCR and antigenemia are useful markers for active infection [30,31].The rates of CMV found in our groups are similar to other services [24,25,[30][31][32].…”

“…CMV is frequently detected in our patients after liver transplantation [24,25,30,31]. Detection of N-PCR and antigenemia are useful markers for active infection [30,31].The rates of CMV found in our groups are similar to other services [24,25,[30][31][32].…”

“…We consider that this high incidence of symptomatic CMV infection is due to the high prevalence of the virus in Brazilian population. The mean time for initial detection CMV is around 29 days following transplantation (range: 0-99 days) [30].. In our service, CMV DNA diagnosed in pretransplantation graft biopsy specimens remained positive posttransplantation on graft biopsies.…”

“…The clinical course of CMV in immunocompetent individuals may be asymptomatic or may resemble "Mononucleosis Syndrome" presented by persistent fever, myalgia, pharyngitis, lymphadenopathy, sweating and hepatosplenomegaly [10,[28][29][30][31][32][33][34].…”

“…Here the product of the first PCR, amplified with a primer pair, is subjected to a new amplification reaction using another pair of primers internal to the first, the product being then detected by agarose gel electrophoresis [62]. Nested PCR technique to diagnose CMV infection produces results consistent with classical culture, reaching 100% specificity and 93% sensitivity in a shorter time frame [63][64][65][66].…”