Human herpesvirus-6 infection after lung and heart-lung transplantation: a prospective longitudinal study.
BACKGROUND
Although human herpesvirus (HHV)-6 is now recognized as a frequent pathogen after transplantation, the real impact of this infection in patients undergoing transplantation remains unclear.


METHODS
During 27 months, 30 consecutive heart-lung- and lung-transplant recipients were included on the day of transplantation and prospectively followed during 100 days for HHV-6 infection.


RESULTS
HHV-6 infection occurred in 20 (66%) patients after a median delay of 18 days after transplantation. The virus was detected by polymerase chain reaction or culture, or both, in 15.7 % of blood specimens, in 14.5% of bronchoalveolar lavage fluids, and in many organs at postmortem examination; it was found by culture in eight patients. No clinical manifestations could clearly be associated with HHV-6 alone. However, patients with HHV-6 infection had a higher mortality rate than patients without HHV-6 infection (7 of 20 vs. 0 of 10; P=0.04), and all the deceased patients died during periods of HHV-6 infection. We did not observe higher incidence of infectious or graft-rejection episodes in HHV-6-positive patients. However, eight of nine viral or fungal infections occurred during HHV-6 infection and three were directly responsible for death.


CONCLUSIONS
Although frequently detected after transplantation, HHV-6 was not associated with any specific clinical manifestation. The higher mortality rate observed in patients with HHV-6 infection was not related to a higher incidence of bacterial infections or graft rejection but might be associated with more viral and fungal infections.
Jacobs
Frédérique
F
Infectious Diseases Clinic, Erasme University Hospital, Brussels, Belgium. fjacobs@ulb.ac.be
Knoop
Christiane
C
Brancart
Françoise
F
Gilot
Philippe
P
Mélot
Christian
C
Byl
Baudouin
B
Delforge
Marie-Luce
ML
Estenne
Marc
M
Liesnard
Corinne
C
D000328:Adult; D002423:Cause of Death; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D016041:Heart-Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D015654:Herpesvirus 6, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000401:mortality / Q000821:virology*; D011446:Prospective Studies; D019349:Roseolovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors
D004279:DNA, Viral; D007166:Immunosuppressive Agents