Transmission of Infection with Herpes Simplex Virus by Renal Transplantation

Js, Dummer; Armstrong, John A.; Somers, Jeremy P.; Kusne, Shimon; Bj, Carpenter; Jt, Rosenthal; M, Ho

doi:10.1093/infdis/155.2.202

Cited by 82 publications

(48 citation statements)

References 13 publications

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“…More recently, we have documented transmission of HSV from donor organ to recipient [3,29]. In one instance [29], two renal transplant recipients had a common donor and both developed primary disseminated skin infection with HSV-2. In the second instance [3], two recipients of cadaveric renal transplant developed a fatal fulminant HSV-2 hepatitis.…”

Section: Discussionmentioning

confidence: 99%

“…We were unable to implicate the transplanted kidney as the source of HSV infection because both the donor and the recipient before transplantation were seronegative for HSV [2]. More recently, we have documented transmission of HSV from donor organ to recipient [3,29]. In one instance [29], two renal transplant recipients had a common donor and both developed primary disseminated skin infection with HSV-2.…”

mentioning

confidence: 99%

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Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Kusne

Schwartz

Breinig

et al. 1991

Journal of Infectious Diseases

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151

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Twelve patients developed herpes simplex (HSV) hepatitis a median of 18 days after solid organ transplantation. This is earlier than cytomegalovirus hepatitis, which usually occurs 30-40 days after transplantation. Eight recipients (67%) died, and in seven, the diagnosis was made at autopsy or <48 h before death. Clinical manifestations associated with mortality were hypotension, disseminated intravascular coagulation (DIC), metabolic acidosis, gastrointestinal bleeding, and bacteremia. Laboratory abnormalities at diagnosis associated with mortality were high creatinine, low platelet counts, prolonged partial thromboplastin time, and a high percentage of band forms on the blood smear. Disseminated HSV disease was noted in four of six patients who had an autopsy and included involvement of lungs in three and the gastrointestinal tract in three. Five recipients developed DIC and all died. Pathologically, HSV hepatitis has two forms, focal and diffuse. All three patients with diffuse liver pathology died. However, three of seven with focal liver pathology survived with antiviral therapy, which suggests that early diagnosis and treatment may be lifesaving. None of these patients had received prophylactic acyclovir. It is possible that acyclovir prophylaxis may be able to prevent this disease.Herpes simplex virus (HSV) hepatitis is considered rare [1]. It has been observed most frequently as part of disseminated HSV in immunologically compromised patients or during pregnancy. Sporadic cases have been reported from this institution in renal transplant recipients and have ended fatally [2,3], as have most cases reported in the literature. Here we report 12 cases that occurred after solid organ transplantation over a 9-year period (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988). This series is large enough to allow us to determine the approximate frequency of HSV hepatitis in our transplantation population; to present the effect of viral dissemination, the nature of the liver pathology, and the range of clinical and laboratory characteristics of the disease; and to investigate prognostic factors. Materials and Methods DefinitionsCases of HSV hepatitis were diagnosed by laboratory, histologic, and clinical findings of one or more of the following in liver tissue from a biopsy or autopsy: isolation of HSV, positive immunoperoxidase staining for HSV antigen, or histology showing intranuclear inclusion bodies and pathology consistent with HSV lesions. In one case there was no liver tissue to examine, and the diagnosis was made by isolation of HSV from multiple sites outside the liver, including buffy coat, and clinical evidence of fulminant hepatitis. The histologic pattern of Laboratory methodsTissue specimens obtained by biopsy or at autopsy were examined after routine staining and processing for detection of HSV antigen by immunoperoxidase staining and, on occasion, processed for isolation of HSV. Other specimens obtained from transplant recipients for viral isolation included throat wash, urine, buffy co...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Kusne

Schwartz

Breinig

et al. 1991

Journal of Infectious Diseases

Self Cite

151

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show abstract

“…Eight were due to reactivation, four were primary disease and only three had HSV skin lesions. HSV hepatitis can be transmitted by donor kidneys (26)(27)(28)(29). The donor source was established by showing that the recipients seroconverted in the early posttransplant period and donor and recipient had identical strains of virus (28,29).…”

Section: Clinical Manifestations Of Hsv Diseasementioning

confidence: 99%

“…HSV hepatitis can be transmitted by donor kidneys (26)(27)(28)(29). The donor source was established by showing that the recipients seroconverted in the early posttransplant period and donor and recipient had identical strains of virus (28,29). These patients did not receive acyclovir prophylaxis and hepatitis continues to be reported in the current era in recipients who do not receive prophylaxis (30,31).…”

Section: Clinical Manifestations Of Hsv Diseasementioning

confidence: 99%

Herpes Simplex and Varicella Zoster Viruses: Forgotten but Not Gone

Miller

Dummer

2007

American Journal of Transplantation

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103

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Herpesvirus infections are common complications of organ transplantation. The most frequent herpesvirus infections are caused by cytomegalovirus (CMV), herpes simplex (HSV) and varicella zoster (VZV). Despite expansion of the therapeutic armamentarium, HSV and VZV continue to cause morbidity and occasional mortality in transplant recipients. Here we review the incidence and risk factors for HSV and VZV disease, their clinical presentation, effects of newer immunosuppressive regimens and prophylaxis for HSV and VZV in solid organ transplant recipients.

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“…Primary infection from the allograft is rare but described in liver and kidney transplant recipients, as well as in other organ types (9)(10)(11)(12). The presentation is often fulminant with hepatitis and poor outcome.…”

Section: A Minority Of Immunocompetent Persons Infected With Hsv Devementioning

confidence: 99%