Härmä M, Höckerstedt K, Lautenschlager I
Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Transplant Proc. 2013 Jun;45(5):1910-2. doi: 10.1016/j.transproceed.2013.01.091.
Human herpesvirus (HHV)-6, comprised of HHV-6A and HHV-6B, belongs to the betaherpesviruses that infect 95%-100% of humans. Primary infection, known as exanthema subitum, occurs in early childhood. Reactivations of latent HHV-6, mostly HHV-6B, are common after liver transplantation. The vast majority of them are asymptomatic; in a minority of cases, the virus may infect the liver transplant, causing graft dysfunction or hepatitis. An association between hepatic HHV-6 infection and indeterminate acute liver failure (ALF) has been shown, but the causality is not clear because of the ubiquitous nature of HHV-6. We have previously observed HHV-6B antigens in the explanted livers of most patients (80%, n = 32) transplanted with ALF of unknown cause, whereas it was not observed among those with ALF of known cause. After transplantation, half of the patients with pretransplant HHV-6 infection (9/18) developed recurrences. The aim of this study was to investigate their long-term course (9-14 years). Half of the patients with pretransplant HHV-6 developed recurrences. Two also showed cytomegalovirus (CMV) hepatitis, whereas none of the other patients demonstrated intrahepatic CMV. During the 9 years or more of follow-up, 1 graft and 2 patients were lost in both groups (HHV-6 recurrence/HHV-6-negative patients). The reasons for graft loss were hepatic arterial thrombosis and portal venous thrombosis. In addition 2 patients died in the HHV-6 recurrence group, one because of rethrombosis of hepatic artery (day 460) and one with a functioning transplant (4.5 years after transplantation). In the control group 1 patient died at 1.5 years and 1 at 10 years after liver transplantation because of pneumonia. HHV-6 relapse was common in ALF patients after transplantation. However, HHV-6 did not cause liver failure and had no significant long-term effect on survival.
人类疱疹病毒（HHV）-6由HHV-6A和HHV-6B组成，属于β疱疹病毒，可感染95%-100%的人类。原发性感染称为幼儿急疹，发生在儿童早期。潜伏的HHV-6（大多数为HHV-6B）在肝移植后重新激活很常见。其中绝大多数没有症状；在少数情况下，病毒可能感染肝移植器官，导致移植物功能障碍或肝炎。已经显示肝HHV-6感染与不明原因的急性肝衰竭（ALF）之间存在关联，但由于HHV-6的普遍存在，因果关系尚不清楚。我们之前在大多数因不明原因ALF接受移植的患者（80%，n = 32）的移植肝中观察到HHV-6B抗原，而在已知原因的ALF患者中未观察到。移植后，移植前感染HHV-6的患者中有一半（9/18）复发。本研究的目的是调查其长期病程（9-14年）。移植前感染HHV-6的患者中有一半复发。两名患者还出现了巨细胞病毒（CMV）肝炎，而其他患者均未出现肝内CMV。在9年或更长时间的随访中，两组（HHV-6复发/HHV-6阴性患者）均有1个移植物丢失和2例患者死亡。移植物丢失的原因是肝动脉血栓形成和门静脉血栓形成。此外，HHV-6复发组有2例患者死亡，1例死于肝动脉再次血栓形成（第460天），1例移植器官功能正常（移植后4.5年）。在对照组中，1例患者在肝移植后1.5年死于肺炎，1例在10年死于肺炎。HHV-6复发在移植后的ALF患者中很常见。然而，HHV-6并未导致肝衰竭，对生存率也没有显著的长期影响。
