title: Early and late virological monitoring of cytomegalovirus, Epstein-Barr virus, and human herpes virus 6 infections in small bowel/multivisceral transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are the major causes of graft failure and posttransplantation mortality among small bowel and multivisceral transplantations (SB/MVT). Little is known about human herpes virus 6 (HHV-6) infections in transplant recipients.
  
  
  OBJECTIVE
  The purposes of this study were to analyze the clinical relevance of CMV, EBV, and HHV-6 infections after small bowel transplantation and to establish whether routine monitoring for HHV-6 infection should be recommended for the prevention of severe complications in this population.
  
  
  METHODS
  Ten adult patients were monitored based on CMV, EBV, and HHV6 DNA quantifications in blood and biopsy tissue samples. Three patients were monitored for at least 5 months (early period) and 7 patients were monitored for 1 to 5 years after transplantation (late period).
  
  
  RESULTS
  In the early period, despite prophylaxis all 3 patients developed symptomatic CMV infections: 1 fever/diarrhea, 1 enteritis and rejection, as well as 1 fever and pneumonia. Only 1 patient developed EBV and HHV-6 infections. The average time of onset of CMV infection was 3 months after transplantation and only 24 days for HHV6 infection. In the late period, of the 7 SB/MVT recipients only 1 developed an EBV infection at 2 years after transplantation. No CMV or HHV-6 infections were identified in any patient.
  
  
  CONCLUSIONS
  CMV infection is a major cause of organ disease and rejection in the early period after transplantation. EBV infection in adult recipients must be considered also in the late period, particularly in association with severe immunosuppression. Because HHV-6 infection occurs earlier than CMV/EBV, it may serve as an indicator for more intense virological surveillance.
authors.affiliation: St.Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Petrisli
authors.forename: A
authors.initials: A
authors.lastname: Chiereghin
authors.forename: L
authors.initials: L
authors.lastname: Gabrielli
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: G
authors.initials: G
authors.lastname: Piccirilli
authors.forename: F
authors.initials: F
authors.lastname: Baccolini
authors.forename: A
authors.initials: A
authors.lastname: Altimari
authors.forename: A
authors.initials: A
authors.lastname: Bagni
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.forename: M P
authors.initials: MP
authors.lastname: Landini
authors.forename: T
authors.initials: T
authors.lastname: Lazzarotto
mesh_terms: D000328:Adult; D001706:Biopsy; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D006566:Herpesviridae Infections / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation* / Q000821:virology; D008168:Lung / Q000821:virology; D019349:Roseolovirus Infections / Q000453:epidemiology / Q000517:prevention & control; D014781:Viscera / Q000473:pathology / Q000637:transplantation* / Q000821:virology
chemical_list: D004279:DNA, Viral