title: Human herpes virus 6 infection in pediatric organ transplant patients.
abstract: Transplant patients need lifelong immunosuppressive medication, but this reduces their defense mechanisms, making them prone to viral infections and reactivations. We aimed to clarify the prevalence and clinical manifestations of the human herpes virus 6 (HHV-6) infection in children after pediatric solid organ transplants. Clinical findings and viral loads were compared between primary HHV-6 infections and reactivations. The study comprised 47 kidney, 25 liver, and 12 heart transplant patients who underwent surgery from 2009 to 2014. HHV-6 antibodies were analyzed before surgery, and HHV-6 DNAemia tests were regularly carried out after the transplant using a real-time quantitative polymerase chain reaction method. We found the primary HHV-6 infection in 19 of 22 (86%) seronegative patients, and it was more common in patients under 3 years of age (79%) than over 3 (38%, P=.0002). Post-transplant HHV-6 DNAemia affected 48 of 84 (57%) patients and was significantly higher in primary infections than reactivations (P=.001), and 17 of 48 (35%) patients had symptoms when it was detected at a median of 2 weeks post-transplant. The HHV-6 infection was common after solid organ transplants, especially under 3 years of age, and it typically started 2 weeks after surgery. Testing for HHV-6 DNAemia is recommended shortly after transplantation, especially in patients with fever, diarrhea, rash, seizures, or abnormal liver enzyme tests.
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ylinen
authors.affiliation: Medical School, University of Helsinki, Helsinki, Finland.
authors.forename: Silja
authors.initials: S
authors.lastname: Lehtinen
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Jahnukainen
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Karlsson
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raisa
authors.initials: R
authors.lastname: Loginov
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Mannonen
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Irmeli
authors.initials: I
authors.lastname: Lautenschlager
authors.affiliation: Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Jalanko
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D015995:Prevalence; D019349:Roseolovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D019562:Viral Load
chemical_list: D007166:Immunosuppressive Agents
keywords: children; human herpes virus 6; infection; pediatric; transplantation