Primary HHV 6 infection after liver transplantation with acute graft rejection and multi‐organ failure: Successful treatment with a 2.5‐fold dose of cidofovir and reduction of immunosuppression

Abstract

HHV type 6 has been reported with enhanced pathogenicity in immunocompromised patients. Herein, we report about a two-yr-old girl who experienced primary HHV 6 infection after liver transplantation. She clinically presented with graft rejection and necrotic hepatitis as well as high fever, pneumonitis with respiratory failure and a rash. Therapy with cidofovir of 5 mg/kg per wk did not show improvement, so that a full pharmacokinetic profile of cidofovir was performed. It demonstrated enhanced body weight normalized clearance of cidofovir and cidofovir dosage was augmented to 12 mg/kg per wk to reach adequate drug exposure. With additional reduction of immunosuppression, the patient dramatically improved and liver function stabilized.

HHV‐6 in liver transplantation: A literature review

“…Patients with clinically significant HHV-6 infection after liver transplantation commonly present with unexplained fever. 8,24,25 Among adult transplant patients with HHV-6 plasma viraemia, five (29.4%) of 17 presented with unexplained fever at the time of reactivation. 8 Fever may be associated with skin rash, 25,26 myelosuppression 27 or elevated transaminases.…”

“…8,24,25 Among adult transplant patients with HHV-6 plasma viraemia, five (29.4%) of 17 presented with unexplained fever at the time of reactivation. 8 Fever may be associated with skin rash, 25,26 myelosuppression 27 or elevated transaminases. [28][29][30]…”

Roseoloviruses in transplant recipients: clinical consequences and prospects for treatment and prevention trials

“…Allograft dysfunction and rejection is gaining more traction as a serious complication of HHV-6B reactivation [44] or primary infection [45], particularly in liver transplantation. Retrospective testing for HHV-6 DNA in 26 liver biopsies was positive in 39% of patients with graft hepatitis of unclear etiology, and confluent periportal necrosis was associated with high viral loads in 4 patients who responded to antiviral therapy [46].…”

Hepatitis due to human herpesvirus 6B after hematopoietic cell transplantation and a review of the literature

“…HHV‐6 infection of transplanted livers may cause increased adhesion molecule expression on vascular endothelial cells resulting in lymphocyte infiltration . Primary infection with HHV‐6 in infants after liver transplantation has been associated with hepatitis and graft rejection . A prospective study in liver transplant patients concluded that HHV‐6 detection in serum by PCR is independently correlated with biopsy‐proven graft rejection .…”