Feldstein Ariel E, Razonable Raymund R, Boyce Thomas G, Freese Deborah K, El-Youssef Mounif, Perrault Jean, Paya Carlos V, Ishitani Michael B
Division of Pediatric Gastroenterology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Pediatr Transplant. 2003 Apr;7(2):125-9. doi: 10.1034/j.1399-3046.2003.00028.x.
Recent studies in adult liver transplant patients have suggested that both human herpesvirus (HHV)-6 and HHV-7 infection are important causes of morbidity following liver transplantation. However, the impact of HHV-6 and -7 infection in pediatric liver transplant patients remains largely unknown. The aims were to determine the prevalence of HHV-6 and -7 infection in pediatric liver transplant patients and to determine whether there is an association between HHV-6 and -7 infection with episodes of graft rejection and cytomegalovirus (CMV) infection. A total of 46 pediatric liver transplant patients transplanted at Mayo Clinic between January 1994 and January 2000 were evaluated. Quantitative polymerase chain reaction (PCR) assays for CMV, HHV-6 and HHV-7 were performed on stored sera obtained prior to transplant, weekly for 8 wk and at 4 months and 1 yr post-transplant. Pretransplant sera were tested for HHV-6 antibodies by indirect immunofluorescence assay. A total of 215 blood samples were tested (mean 6.5 +/- 3.1, range 3-18). CMV infection occurred in 11 of 33 (33.3%) patients, while CMV disease occurred in 4 of 33 (12%) patients. Infection with HHV-6 (variant B) was detected in three of 33 (9.1%) patients. HHV-7 infection was not detected. Case 1 and 2 were infants (10- and 11-month old, respectively). Both were seronegative for HHV-6 pretransplant. In both cases, HHV-6 infection was associated with concurrent episodes of moderate to severe acute graft rejection. Case 3 was a 16-yr-old girl who was seropositive for HHV-6 pretransplant. No clinical events were recorded and a liver biopsy performed per protocol showed no evidence of rejection. None of the three patients had concomitant CMV infection or disease. In this study, HHV-6 infection occurred in 9% of pediatric liver transplant patients while HHV-7 was not detected. A potential association between primary HHV-6 infection and allograft rejection warrants further investigation.
近期针对成人肝移植患者的研究表明，人类疱疹病毒（HHV）-6和HHV-7感染都是肝移植后发病的重要原因。然而，HHV-6和-7感染对小儿肝移植患者的影响在很大程度上仍不清楚。本研究旨在确定小儿肝移植患者中HHV-6和-7感染的发生率，并确定HHV-6和-7感染与移植排斥反应发作及巨细胞病毒（CMV）感染之间是否存在关联。对1994年1月至2000年1月在梅奥诊所接受移植的46例小儿肝移植患者进行了评估。在移植前、移植后每周8周以及移植后4个月和1年采集的储存血清中，进行了CMV、HHV-6和HHV-7的定量聚合酶链反应（PCR）检测。通过间接免疫荧光法检测移植前血清中的HHV-6抗体。共检测了215份血样（平均6.5±3.1份，范围3 - 18份）。33例患者中有11例（33.3%）发生CMV感染，33例患者中有4例（12%）发生CMV疾病。33例患者中有3例（9.1%）检测到HHV-6（B型变异株）感染。未检测到HHV-7感染。病例1和病例2为婴儿（分别为10个月和11个月大）。二者移植前HHV-6血清学均为阴性。两例中，HHV-6感染均与中度至重度急性移植排斥反应的并发发作相关。病例3为一名16岁女孩，移植前HHV-6血清学呈阳性。未记录到临床事件，按方案进行的肝活检未显示排斥反应证据。这3例患者均无CMV感染或疾病。在本研究中，9%的小儿肝移植患者发生HHV-6感染，未检测到HHV-7感染。原发性HHV-6感染与同种异体移植排斥反应之间的潜在关联值得进一步研究。
