Association of HHV-6 With Outcomes in CMV-seronegative Liver Transplant Recipients With CMV-seropositive Donors Receiving Preemptive Antiviral Therapy

Abstract

Background. Risk factors, virological parameters, and outcomes associated with HHV-6 viremia in high-risk donor CMV-seropositive and recipient CMV-seronegative (D+R–) liver transplant recipients in the current era are incompletely defined. Methods. The study population consisted of patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus valganciclovir prophylaxis for CMV prevention in D+R– liver transplant recipients. Weekly blood samples through 100 d in the PET group were tested for HHV-6 viremia using a real-time quantitative polymerase chain reaction. Assessments included virological characteristics and relationship with CMV, risk factors, and impact of HHV-6 viremia with outcomes through 12 mo posttransplant. Results. HHV-6 viremia at any level developed in 42% (40 of 96). Older patient age (P = 0.03), longer hospitalization (P = 0.015), and ICU stay at transplantation (P = 0.029) were significantly associated with high-grade viremia. Concurrent HHV-6 and CMV viremia was associated with earlier onset of HHV-6 viremia (P = 0.004), higher HHV-6 area under the curve (P = 0.043), and higher peak HHV-6 viral load (P = 0.006) versus HHV-6 viremia alone. High-grade viremia was independently associated with biopsy-proven rejection within 12 mo (P = 0.045) posttransplant. Conclusions. Among D+R– liver transplant recipients receiving valganciclovir as PET, high-grade HHV-6 viremia was associated with increased age and critical illness in ICU at time of transplant and was independently associated with allograft rejection.

Healthcare disparity and its associations with cytomegalovirus disease in pediatric liver transplant recipients in South Africa

“…HHV 6 reactivation can precede CMV infection 33 , 34 , 35 , 36 and heightened immunosuppression is associated with reactivation of multiple herpesviruses. 37 , 38 , 39 The seroprevalence of HHV 8 in Africa is high (>50%) compared to that described in HIC settings such as Northern Europe and North America (<5%).…”

Current Perspectives on the Management of Herpesvirus Infections in Solid Organ Transplant Recipients

“…The majority of reactivations are asymptomatic, but some can manifest as fever, rash, bone marrow suppression, and organ involvement such as hepatitis, colitis, pneumonitis, and, sporadically, encephalitis [ 149 , 150 , 154 ]. Regarding the impact on the allograft, only high-grade HHV6 DNAemia (>10 5 copies/mL) is associated with acute allograft rejection in HCMV D+/R− LiTR [ 155 ].…”