Human herpes virus 6 infection in pediatric organ transplant patients

Abstract

Transplant patients need lifelong immunosuppressive medication, but this reduces their defense mechanisms, making them prone to viral infections and reactivations. We aimed to clarify the prevalence and clinical manifestations of the human herpes virus 6 (HHV-6) infection in children after pediatric solid organ transplants. Clinical findings and viral loads were compared between primary HHV-6 infections and reactivations. The study comprised 47 kidney, 25 liver, and 12 heart transplant patients who underwent surgery from 2009 to 2014. HHV-6 antibodies were analyzed before surgery, and HHV-6 DNAemia tests were regularly carried out after the transplant using a real-time quantitative polymerase chain reaction method. We found the primary HHV-6 infection in 19 of 22 (86%) seronegative patients, and it was more common in patients under 3 years of age (79%) than over 3 (38%, P=.0002). Post-transplant HHV-6 DNAemia affected 48 of 84 (57%) patients and was significantly higher in primary infections than reactivations (P=.001), and 17 of 48 (35%) patients had symptoms when it was detected at a median of 2 weeks post-transplant. The HHV-6 infection was common after solid organ transplants, especially under 3 years of age, and it typically started 2 weeks after surgery. Testing for HHV-6 DNAemia is recommended shortly after transplantation, especially in patients with fever, diarrhea, rash, seizures, or abnormal liver enzyme tests.

Clinical course of human herpesvirus 6 infection in pediatric living donor liver transplantation

“…Previous studies suggested that the detection of viral DNA in plasma may be a good tool for monitoring active viral infection; however, a low frequency of HHV‐6 infection has been demonstrated in liver transplant recipients . The frequency of HHV‐6 infection determined using real‐time PCR is affected by assay sensitivity, clinical specimen being tested, and the administration of prophylactic antiviral treatment . The relatively high frequency of HHV‐6 infection in this study may be due to the fact that prophylactic ganciclovir treatment was not administered to the LDLT recipients.…”

“…12,22 The frequency of HHV-6 infection determined using real-time PCR is affected by assay sensitivity, clinical specimen being tested, and the administration of prophylactic antiviral treatment. 23 The relatively high frequency of HHV-6 infection in this study may be due to the fact that prophylactic ganciclovir treatment was not administered to the LDLT recipients.…”

Primary infection with human herpes virus type 6, post‐pediatric liver transplantation—A pathogen to remember

“…Primary HHV‐6 infection post‐liver transplantation was defined as: HHV‐6 DNAemia in children who were seronegative (IgG) prior to transplantation. Seroconversion from negative to positive IgG posttransplantation. …”

“…Whereas a primary, as well as a non‐primary infection with other types of infections from the herpesviridae family, have been well‐described. Studies reporting on a primary infection with HHV‐6, post‐pediatric LT are scarce . Most of the previous investigations have dealt with HHV‐6 post‐LT in general (primary and non‐primary), but none have focused on children with only a primary infection.…”

Pure red cell aplasia with isolated human herpes virus 6 infection of bone marrow in postcardiac transplant patient

“…In adult cardiac transplant patients with HHV‐6 infections, overall morbidity and mortality are increased . In the pediatric literature, a series of 84 children after solid organ transplant demonstrated a 28% rate of symptomatic HHV‐6 viremia . While cytopenias are reported with HHV‐6 even in immunocompetent patients, PRCA has not been reported in the posttransplant literature.…”