Härmä Maiju, Höckerstedt Krister, Krogerus Leena, Lautenschlager Irmeli
Department of Surgery, Transplantation and Liver Surgery Clinic, and Transplant Unit Research Laboratory, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
Transplantation. 2006 Feb 15;81(3):367-72. doi: 10.1097/01.tp.0000195771.83614.0b.
Acute liver failure (ALF) is a significant cause of liver transplantation. We have previously reported that human herpesvirus-6 (HHV-6) was found in most livers of patients with ALF of unknown origin ending up with liver transplantation. In this study, we investigated the posttransplant HHV-6 infection of the liver graft in these patients.
Thirty-two patients transplanted due to ALF were included in this retrospective study. Twelve of the 15 patients with unknown cause and four of 17 patients with a known cause of ALF had HHV-6 antigens in the explanted liver. Altogether, 18 patients had some pretransplant evidence of HHV-6. After transplantation, the patients were frequently monitored for the viruses, and biopsy histology was performed in every case of graft dysfunction. HHV-6 was demonstrated in liver tissue by immunohistochemistry.
During the follow-up of 6 months, hepatic HHV-6 infection was demonstrated in 9 of the 18 patients, at a mean 19 days (6-38 days) after transplantation. All patients with posttransplant HHV-6 showed graft dysfunction. In biopsy histology, seven out of these nine patients demonstrated viral infection, one of them also having CMV antigens in the liver. None of those patients without evidence of pretransplant HHV-6 showed HHV-6 in the posttransplant biopsies. Posttransplant HHV-6 was not treated and the virus had no effect on 1-year patient or graft survivals.
Pretransplant hepatic HHV-6 infection of patients with ALF is a risk factor for posttransplant HHV-6 infection and liver dysfunction, but has no effect on 1-year graft or patient survival.
急性肝衰竭（ALF）是肝移植的一个重要原因。我们之前报道过，在因不明原因的ALF最终接受肝移植的患者的大多数肝脏中发现了人类疱疹病毒6型（HHV-6）。在本研究中，我们调查了这些患者肝移植后肝脏移植物的HHV-6感染情况。
本回顾性研究纳入了32例因ALF接受移植的患者。15例病因不明的患者中有12例，17例已知病因的ALF患者中有4例，其移植肝中存在HHV-6抗原。总共有18例患者在移植前有一些HHV-6感染的证据。移植后，对患者进行病毒的频繁监测，并且在每例移植物功能障碍的病例中都进行了活检组织学检查。通过免疫组织化学在肝组织中检测到HHV-6。
在6个月的随访期间，18例患者中有9例在移植后平均19天（6 - 38天）出现肝脏HHV-6感染。所有移植后感染HHV-6的患者均出现移植物功能障碍。在活检组织学检查中，这9例患者中有7例显示病毒感染，其中1例肝脏中也有巨细胞病毒（CMV）抗原。那些在移植前没有HHV-6感染证据的患者在移植后的活检中均未显示HHV-6感染。移植后HHV-6未进行治疗，该病毒对患者1年生存率或移植物生存率没有影响。
ALF患者移植前肝脏HHV-6感染是移植后HHV-6感染和肝功能障碍的危险因素，但对1年移植物或患者生存率没有影响。
