Monitoring for HHV-6 infection after renal transplantation: evaluation of risk factors for sustained viral replication.
BACKGROUND
Human herpesvirus-6 (HHV-6) is known to reactivate after renal transplantation and has been associated with several clinical manifestations. Risk factors for sustained viral replication, however, remain unclear.


METHODS
Thirty consecutive kidney transplant patients were prospectively followed for HHV-6 replication between February 2007 and February 2008. Plasma samples for DNA detection were collected from the donor and the recipient before transplantation and from the recipient weekly for the first 2 months after transplantation and then every 2 weeks for 2 additional months. HHV-6 active infection was defined as detection of viral DNA in plasma, by polymerase chain reaction, in at least two consecutive samples over an interval of at least 1 week.


RESULTS
Active viral infection was detected in 25% of the recipients before transplantation and 27% (8 of 30) of the patients after transplantation. The mean time to onset of viral replication was 28.1 days after transplantation and 7 of 8 (87.5%) were asymptomatic. Risk factors associated with active HHV-6 infection were receiving an organ from a living donor (P=0.028), recipients with IgM antibodies detected before transplantation (P=0.005), and pretransplantation recipient HHV-6 viral load more than 10,000 copies/mL plasma (P=0.034).


CONCLUSIONS
Active HHV-6 infection occurs early after renal transplantation and is mostly asymptomatic. Donor or recipient infection may occur at the time of transplantation and are related to higher rates of posttransplantation infections.
Department of Infectious Diseases, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil.
Claudia R
CR
Luiz
Clarisse M
CM
Machado
Cynthia L M
CL
Canto
Silvia C C
SC
Christ
Jose O M
JO
Pestana
Camille N
CN
Kotton
Luis F A
LF
Camargo
D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006566:Herpesviridae Infections / Q000150:complications* / Q000175:diagnosis*; D015654:Herpesvirus 6, Human / Q000378:metabolism*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014779:Virus Replication
D004279:DNA, Viral