Human herpes virus 6 infection in pediatric organ transplant patients
Elisa Ylinen1, Silja Lehtinen2, Timo Jahnukainen1
1Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Human herpes virus 6 (HHV-6) infection is common in children after solid organ transplants, particularly those under 3 years old. Early DNAemia testing is recommended to detect infections and guide management.
Area of Science:
- Virology
- Immunology
- Pediatric Transplant Medicine
Background:
- Solid organ transplant recipients require lifelong immunosuppression, increasing susceptibility to viral infections.
- Human herpes virus 6 (HHV-6) is a significant opportunistic pathogen in immunocompromised individuals.
Purpose of the Study:
- To determine the prevalence and clinical features of HHV-6 infection in pediatric solid organ transplant recipients.
- To compare clinical findings and viral loads between primary HHV-6 infections and reactivations.
Main Methods:
- Analysis of HHV-6 antibodies pre-transplant and HHV-6 DNAemia post-transplant via real-time quantitative PCR.
- Study included 84 pediatric patients (kidney, liver, heart) from 2009-2014.
Main Results:
- Primary HHV-6 infection occurred in 86% of seronegative patients, predominantly in those under 3 years (79%).
- Post-transplant HHV-6 DNAemia was detected in 57% of patients, higher in primary infections.
- Symptoms were present in 35% of patients with DNAemia, typically detected 2 weeks post-transplant.
Conclusions:
- HHV-6 infection is highly prevalent in pediatric solid organ transplant recipients, especially younger children.
- Early post-transplant HHV-6 DNAemia testing is crucial, particularly in symptomatic patients.
- Prompt detection aids in managing potential complications associated with HHV-6 infection.
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.
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