Razonable Raymund R, Lautenschlager Irmeli
Raymund R Razonable, Division of Infectious Diseases, Department of Medicine, and the William J von Liebig Transplant Center, College of Medicine, Mayo Clinic, Rochester, MN 55905, United States.
World J Hepatol. 2010 Sep 27;2(9):345-53. doi: 10.4254/wjh.v2.i9.345.
Human herpes virus 6 (HHV-6) infects > 95% of humans. Primary infection which occurs mostly during the first 2 years of life in the form of roseola infantum, non-specific febrile illness, or an asymptomatic illness, results in latency. Reactivation of latent HHV-6 is common after liver transplantation. Since the majority of human beings harbor the latent virus, HHV-6 infections after liver transplantation are most probably caused by endogenous reactivation or superinfection. In a minority of cases, primary HHV-6 infection may occur when an HHV-6-seronegative individual receives a liver allograft from an HHV-6-seropositive donor. The vast majority of HHV-6 infections after liver transplantation are asymptomatic. Only in a minority of cases, when HHV-6 causes a febrile illness associated with rash and myelosuppression, hepatitis, gastroenteritis, pneumonitis, and encephalitis after liver transplantation. In addition, HHV-6 has been implicated in a variety of indirect effects, such as allograft rejection and increased predisposition to and severity of other infections, including cytomegalovirus, hepatitis C virus, and opportunistic fungi. Because of the uncommon nature of the clinical illnesses directly attributed to HHV-6, there is currently no recommended HHV-6-specific approach prevention after liver transplantation. Asymptomatic HHV-6 infection does not require antiviral treatment, while treatment of established HHV-6 disease is treated with intravenous ganciclovir, foscarnet, or cidofovir and this should be complemented by a reduction in immunosuppression.
人类疱疹病毒6型（HHV-6）感染了超过95%的人类。初次感染主要发生在生命的头两年，表现为幼儿急疹、非特异性发热性疾病或无症状疾病，之后会进入潜伏期。肝移植后，潜伏的HHV-6重新激活很常见。由于大多数人都携带这种潜伏病毒，肝移植后的HHV-6感染很可能是由内源性激活或重叠感染引起的。在少数情况下，当HHV-6血清阴性个体接受来自HHV-6血清阳性供体的肝脏同种异体移植时，可能会发生原发性HHV-6感染。肝移植后绝大多数HHV-6感染是无症状的。只有在少数情况下，HHV-6会在肝移植后引起与皮疹和骨髓抑制、肝炎、肠胃炎、肺炎及脑炎相关的发热性疾病。此外，HHV-6还与多种间接影响有关，如移植排斥反应以及增加对其他感染（包括巨细胞病毒、丙型肝炎病毒和机会性真菌）的易感性和感染严重程度。由于直接归因于HHV-6的临床疾病并不常见，目前肝移植后尚无推荐的HHV-6特异性预防方法。无症状的HHV-6感染不需要抗病毒治疗，而确诊的HHV-6疾病则用静脉注射更昔洛韦、膦甲酸钠或西多福韦治疗，同时应减少免疫抑制。
