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Donor‐to‐recipient transmission and reactivation in a kidney transplant recipient of an inherited chromosomally integrated HHV‐6A: Evidence and outcomes
Author(s) -
Petit Vivien,
Bonnafous Pascale,
Fages Victor,
GautheretDejean Agnès,
Engelmann Ilka,
Baras Agathe,
Hober Didier,
Gérard Romain,
Gibier JeanBaptiste,
Leteurtre Emmanuelle,
Glowacki François,
Moulonguet Florence,
Decaestecker Antoine,
Provôt François,
Chamley Paul,
Faure Emmanuel,
Prusty Bhupesh K.,
Maanaoui Mehdi,
Hazzan Marc
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16067
Subject(s) - transmission (telecommunications) , kidney transplant , virology , immunofluorescence , kidney , immunology , medicine , bk virus , biology , kidney transplantation , pathology , antibody , genetics , electrical engineering , engineering
Human herpesvirus (HHV)‐6A can be inherited and chromosomally integrated (iciHHV‐6A), and donor‐to‐recipient transmission has been reported in solid organ transplant. However, when HHV‐6A reactivation happens after transplant, the source of HHV‐6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor‐to‐recipient transmission and reactivation of iciHHV‐6A through kidney transplant. The absence of HHV‐6A genome from the nails of the recipient excluded a recipient‐related iciHHV‐6A. Viral loads > 7 log 10 copies/10 6 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV‐6A strains are proof of donor‐related transmission. Detection of noncoding HHV‐6 snc‐RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV‐6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV‐6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis.