Human herpesvirus-6 in liver transplant recipients: role in pathogenesis of fungal infections, neurologic complications, and outcome.
BACKGROUND
The clinical impact and relevance of human herpesvirus-6 (HHV-6) infection in liver transplant recipients, has not been fully discerned.


METHODS
A prospective study of 80 consecutive liver transplant recipients was performed using surveillance cultures for HHV-6 at weeks 2, 3, 4, and 6 after transplantation. Viral isolation was used for the detection of HHV-6.


RESULTS
HHV-6 infection occurred in 39% (31 of 80) of the patients. Patients with HHV-6 infection were more likely to have hepatocellular carcinoma as underlying liver disease (P=.09). Mental status changes of unidentifiable etiology were significantly more likely to occur in patients with HHV-6 compared with those without (26%, 9 of 31 vs. 6%, 3 of 49, P=.008). HHV-6 infection was an independent predictor of invasive fungal infections (odds ratio 8.3, 95% confidence interval, 1.2-58.0, P=.03). A significant association between HHV-6 infection and CMV infection after transplantation, CMV recipient and donor serostatus, rejection, or fever of unknown origin, could not be documented. Mortality at last follow-up in patients with HHV-6 infection (29%, 9 of 31) was significantly greater than those without HHV-6 (6%, 3 of 49, P=.008).


CONCLUSIONS
Central nervous system complications of unknown etiology after liver transplantation may be related to HHV-6 infection. HHV-6 viremia was an independently significant predictor of invasive fungal infections and was associated with late mortality in liver transplantation recipients.
University of Pittsburgh Medical Center, VA Medical Center, and Thomas E Starzl Transplantation Institute, Pennsylvania 15240, USA.
J
J
Rogers
S
S
Rohal
D R
DR
Carrigan
S
S
Kusne
K K
KK
Knox
T
T
Gayowski
M M
MM
Wagener
J J
JJ
Fung
N
N
Singh
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006084:Graft Rejection; D006566:Herpesviridae Infections / Q000150:complications*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology*; D011446:Prospective Studies; D014766:Viremia / Q000150:complications