Cytomegalovirus, Human Herpesvirus-6, and Human Herpesvirus-7 in Adult Liver Transplant Recipients: Diagnosis Based on Antigenemia

Abstract

Human herpesvirus (HHV)-6, HHV-7, and cytomegalovirus (CMV) that remain latent after primary infection can be reactivated during immunosuppression following organ transplantation in liver transplant recipients. The aim of this study was to monitor active infections for HHV-6, HHV-7, and CMV among adult liver transplantation recipients using antigenemia detected by an immunoperoxidase staining. Twenty-eight adult liver transplant patients were monitored using antigenemia in blood samples obtained at the time of transplantation, as well as weekly in the first month and once a month for 6 months. Of these patients, 28.5% showed positive CMV antigenemia; 39.2%, HHV-6 antigenemia; and 14.2%, HHV-7 antigenemia. The detection of the three viruses was considered to be independent of one another (P>.05). The results described above showed that few patients remain free of beta herpesviruses after liver transplantation. Most patients were infected sequentially and not concurrently. Antigenemia has been considered useful to detect active HHV-6 and HHV-7 infections. Antigenemia can be more efficiently interpreted when compared with polymerase chain reaction results, although other studies are necessary to establish the reference of HHV-6 and HHV-7 antigenemia.

Cytomegalovirus Infection in Liver Transplantation

“…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].…”

“…With age the increased prevalence of antibodies is common. This may not depend on the geographical area, but the socio-economic status may be important [10,[23][24][25][26][27][28]. The seroprevalence of CMV in populations at high socioeconomic level varies from 40% to 60%, increases after infection of early childhood and approximately 10% to 20% of children have their first infection episode before puberty [10].…”

“…Early diagnosis is important as early treatment of asymptomatic active infection reduces morbidity [24,31,46,47]. The first method of diagnosis used to identify the CMV was exfoliative cytology.…”

“…CMV antigenemia is one of the earlier tests with positive results [17,25,[51][52][53][54][55][56][57][58] and becomes positive on average 9-18 days before establishment of the disease. It has been widely used for the early detection of active infection in organ transplant recipients [17,24,25,36,56].…”

“…The intermediate phase lasts 24 hours, characterized by transcription and replication of viral DNA. The first step of viral gene expression is the synthesis of mRNA via host RNA polymerase inside the core.…”