HHV‐6 and HHV‐7 antigenemia related to CMV infection after liver transplantation

Abstract

HHV-6 and HHV-7 antigenemia usually occurred together with symptomatic CMV infection after liver transplantation. HHV-6 preceded CMV, but HHV-7 appeared together with CMV. Further investigation of the clinical significance of HHV-6 and HHV-7 antigenemia in organ transplant patients is necessary.

Betaherpesviruses in Adult Liver Transplant Recipients

“…Our symptomatic CMV incidence (34.4%) was higher (1.54-fold) than incidence reported by Humar et al (2000) that reported symptomatic CMV infection in 21.6% of the patients. Similar to this study, Härmä et al (2006) found 30% of symptomatic CMV infection during 3 first months after transplantation.…”

“…Although we have found that symptomatic CMV infection was present in most cases of liver dysfunction and graft rejection, CMV co-infection with HHV-6 or HHV-7 and HHV-6 alone were more likely related with graft rejection than CMV alone. Härmä et al (2006) had suggested a role of HHV-6 in liver dysfunction and graft rejection (with HHV-6 antigens detected in liver biopsies in same patients). Griffiths et al (1999) found also association between liver dysfunction and graft rejection with HHV-6 and dysfunction with HHV-7.…”

Human herpesvirus 6 infections after liver transplantation

“…The direct clinical manifestations due to HHV-6 include a febrile illness with or without rash, myelosuppression, hepatitis, pneumonitis and neurological diseases [33,[36][37][38] . The indirect effects attributed to HHV-6 include an exacerbation of cytomegalovirus (CMV) disease, an increased severity of hepatitis C virus (HCV) recurrence, an increased risk of other opportunistic infections, allograft dysfunction, and acute cellular rejection (Table 1) [33,36,[39][40][41][42][43][44][45] . Direct HHV-6 effects Fever and rash: The most frequently reported clinical presentation of HHV-6 infection after liver transplantation is a febrile illness that can be associated with a rash [34,36,46] .…”

“…Fever and rash [36] Increased incidence and severity of cytomegalovirus disease [31,40,41] Hepatitis [33,36,49] Earlier and more severe recurrence of hepatitis C virus [42] Myelosuppression [37] Higher incidence of fungal infections [44] Pneumonitis [37] Higher incidence of opportunistic Infection [36] Neurologic illness [38,44,51] Higher incidence of allograft rejection [33,36,45,53] …”

“…This finding was again demonstrated in a prospective study wherein liver transplant recipients who developed CMV disease had detectable HHV-6 DNA in the blood [31] . Recently, a retrospective study showed that 16 of 19 liver transplant recipients who developed symptomatic CMV infection had concomitant HHV-6 antigenemia, including 12 patients who developed HHV-6 infection prior to CMV antigenemia [40] . However, this association between HHV-6 and CMV was not observed in a large cohort of solid organ transplant recipients who received oral ganciclovir and valganciclovir prophylaxis, wherein the incidence of CMV disease was not significantly different between those who develop and those who did not develop HHV-6 DNAemia [41] .…”