Human herpesvirus 6 seronegativity before transplantation predicts the occurrence of fungal infection in liver transplant recipients.
BACKGROUND
Invasive fungal infection has a major impact on the morbidity and mortality of liver transplant recipients. Human herpesvirus (HHV)-6 infection after transplantation is associated with an immunosuppressive state and the development of cytomegalovirus disease. Because cytomegalovirus infection is a risk factor for invasive fungal infection after transplantation, we have examined whether HHV-6 and fungal infection are associated after transplantation.


METHODS
Pretransplantation sera from 247 consecutive liver transplant recipients were analyzed for IgG to HHV-6. Thirty-three (13%) HHV-6-seronegative recipients were identified. Six of 33 (18%) seronegative recipients experienced fungal infection as compared with 15 of 214 (7%) seropositive recipients (P=0.034).


RESULTS
In a univariate analysis of risk factors for fungal infection, pretransplantation seronegativity to HHV-6 (P=0.034), intraoperative cryoprecipitate requirements greater than the 75th percentile (P=0.035), reoperation (P=0.005), biliary stricturing postoperatively (P=0.046), and gastrointestinal or vascular complications postoperatively (P=0.030) were identified as significant risk factors. Moreover, in pairwise multivariate analysis, pretransplantation HHV-6 seronegativity remained a significant variable even in the presence of each of the other variables.


CONCLUSIONS
These results suggest that HHV-6 seronegativity before transplantation is a valuable clinical marker that identifies patients at risk for developing fungal infection after transplantation.
Division of Infectious Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
D H
DH
Dockrell
J C
JC
Mendez
M
M
Jones
W S
WS
Harmsen
D M
DM
Ilstrup
T F
TF
Smith
R H
RH
Wiesner
R A
RA
Krom
C V
CV
Paya
D018572:Disease-Free Survival; D005260:Female; D006566:Herpesviridae Infections / Q000150:complications* / Q000175:diagnosis; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000821:virology; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors