Premium
Evaluation of liver failure in a pediatric transplant recipient of a liver allograft with inherited chromosomally integrated HHV‐6B
Author(s) -
Bonnafous Pascale,
Phan Tuan L.,
Himes Ryan,
Eldin Karen,
GautheretDejean Agnès,
Prusty Bhupesh K.,
Agut Henri,
Munoz Flor M.
Publication year - 2020
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.25600
Subject(s) - liver transplantation , biology , genotyping , transplantation , virology , viral load , population , immunology , viral hepatitis , gene , virus , genotype , medicine , genetics , environmental health
Abstract Background Active infections of human herpesvirus 6B (HHV‐6B) are frequent in immunocompromised recipients after transplantation. Nevertheless, they need to be distinguished from latent inherited chromosomally integrated genomes (iciHHV‐6) present in about 1% of the population to avoid unnecessary administration of toxic antivirals. Methods A 5‐year‐old child presented with acute liver allograft rejection associated with HHV‐6 DNA in plasma, which led to an unfavorable outcome. We investigated the possibility of HHV‐6 infection derived from an iciHHV‐6 present in the donor's liver using molecular and histopathology studies in various tissues, including quantification of HHV‐6 DNA, genotyping, sequencing for antiviral resistance genes, relative quantification of viral transcripts, and detection of gB and gH viral proteins. Results The presence of iciHHV‐6B was evidenced in the donor with signs of reactivation in the gallbladder and transplanted liver (detection of HHV‐6B mRNA and late proteins). This localized expression could have played a role in liver rejection. Low viral loads in the recipient's plasma, with identical partial U39 sequences, were in favor of viral DNA released from the transplanted liver rather than a systemic infection. Conclusions Determination of iciHHV‐6 status before transplantation should be considered to guide clinical decisions, such as antiviral prophylaxis, viral load monitoring, and antiviral therapy.