Lindahl Jørn Petter, Dörje Christina, Kro Grete Birkeland, Grzyb Krzyztof, Hugenschmidt Harald, Hov Johannes Espolin Roksund, Barratt-Due Andreas, Midtvedt Karsten
Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Department of Microbiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Front Transplant. 2025 May 13;4:1591855. doi: 10.3389/frtra.2025.1591855. eCollection 2025.
Current screening practices have significantly reduced the transmission of donor-derived infections through organ transplantations. However, in exceptional cases, a deceased donor may harbor an undetected active infection, or abnormal blood test results may be mistakenly attributed to the dying process, resulting in missed infections. These ongoing infections can then be transmitted through the grafts. This report presents a case of confirmed donor-derived herpes simplex virus type 1 (HSV-1) hepatitis following kidney transplantation. The HSV-1 infection in the recipient was initially overlooked and misattributed to a probable mycophenolate mofetil-induced etiology, which led to a delay in initiating antiviral therapy. The recipient subsequently developed HSV-1 hepatitis, which progressed to liver failure and multiorgan failure, ultimately resulting in death. As a result of this case, our transplant center promptly revised its screening and prophylactic antiviral treatment protocols. All kidney transplant recipients who are herpes simplex virus (HSV) antibody-negative now receive valaciclovir until the donor's HSV DNA PCR status is confirmed to be negative.
目前的筛查措施已显著减少了通过器官移植传播的供体源性感染。然而，在特殊情况下，已故供体可能携带未被检测到的活动性感染，或者异常的血液检测结果可能被错误地归因于濒死过程，从而导致感染漏诊。这些持续存在的感染随后可通过移植物传播。本报告介绍了1例肾移植后确诊的供体源性1型单纯疱疹病毒（HSV-1）肝炎病例。受者的HSV-1感染最初被忽视，并被错误地归因于可能由霉酚酸酯引起的病因，这导致了抗病毒治疗的延迟启动。受者随后发展为HSV-1肝炎，进而发展为肝衰竭和多器官衰竭，最终导致死亡。鉴于此病例，我们的移植中心迅速修订了其筛查和预防性抗病毒治疗方案。所有单纯疱疹病毒（HSV）抗体阴性的肾移植受者现在都接受伐昔洛韦治疗，直至供体的HSV DNA PCR状态被确认为阴性。
