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. 2010 Sep 27;2(9):345-53.
doi: 10.4254/wjh.v2.i9.345.

Impact of human herpes virus 6 in liver transplantation

Raymund R Razonable  1 , Irmeli Lautenschlager
Affiliations

Impact of human herpes virus 6 in liver transplantation

Raymund R Razonable et al. World J Hepatol. .

Abstract

Human herpes virus 6 (HHV-6) infects > 95% of humans. Primary infection which occurs mostly during the first 2 years of life in the form of roseola infantum, non-specific febrile illness, or an asymptomatic illness, results in latency. Reactivation of latent HHV-6 is common after liver transplantation. Since the majority of human beings harbor the latent virus, HHV-6 infections after liver transplantation are most probably caused by endogenous reactivation or superinfection. In a minority of cases, primary HHV-6 infection may occur when an HHV-6-seronegative individual receives a liver allograft from an HHV-6-seropositive donor. The vast majority of HHV-6 infections after liver transplantation are asymptomatic. Only in a minority of cases, when HHV-6 causes a febrile illness associated with rash and myelosuppression, hepatitis, gastroenteritis, pneumonitis, and encephalitis after liver transplantation. In addition, HHV-6 has been implicated in a variety of indirect effects, such as allograft rejection and increased predisposition to and severity of other infections, including cytomegalovirus, hepatitis C virus, and opportunistic fungi. Because of the uncommon nature of the clinical illnesses directly attributed to HHV-6, there is currently no recommended HHV-6-specific approach prevention after liver transplantation. Asymptomatic HHV-6 infection does not require antiviral treatment, while treatment of established HHV-6 disease is treated with intravenous ganciclovir, foscarnet, or cidofovir and this should be complemented by a reduction in immunosuppression.

Keywords: Antivirals; Human herpes virus 6; Liver transplantation; Opportunistic infections.

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Figures

Figure 1
Figure 1
The histological findings associated with intragraft human herpes virus 6 infection. A: Portal area with mild lymphocyte dominated inflammatory infiltrate (H&E staining, original magnification × 400); B: Human herpes virus 6 positive cells in the portal area demonstrated by immunohistochemistry (original magnification × 1000). From Härmä et al. Transplantation 2006; 81: 367-372 with permission[52].
Figure 2
Figure 2
Human herpesvirus-6 positive cells in the gastroduodenal mucosa demonstrated by immunohistochemistry (original magnification × 400). (Courtesy of Dr. Johanna Arola, University of Helsinki, Finland).
See this image and copyright information in PMC

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