Donor‐to‐recipient transmission and reactivation in a kidney transplant recipient of an inherited chromosomally integrated HHV‐6A: Evidence and outcomes. Issue 12 (28th June 2020)

• Record Type: Journal Article
• Authors: Petit, Vivien; Bonnafous, Pascale; Fages, Victor; Gautheret‐Dejean, Agnès; Engelmann, Ilka; Baras, Agathe; Hober, Didier; Gérard, Romain; Gibier, Jean‐Baptiste; Leteurtre, Emmanuelle; Glowacki, François; Moulonguet, Florence; Decaestecker, Antoine; Provôt, François; Chamley, Paul; Faure, Emmanuel; Prusty, Bhupesh K.; Maanaoui, Mehdi; Hazzan, Marc
• Is Part Of: American journal of transplantation. Volume 20:Issue 12(2020)
• Page Start: 3667
• Page End: 3672
• Publication Date: 2020-06-28
• Subjects: clinical research/practice -- infection and infectious agents – viral: human herpesvirus 6 (HHV‐6) -- infectious disease -- kidney disease: infectious -- kidney transplantation/nephrology -- translational research/science; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16067
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Human herpesvirus (HHV)‐6A can be inherited and chromosomally integrated (iciHHV‐6A), and donor‐to‐recipient transmission has been reported in solid organ transplant. However, when HHV‐6A reactivation happens after transplant, the source of HHV‐6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor‐to‐recipient transmission and reactivation of iciHHV‐6A through kidney transplant. The absence of HHV‐6A genome from the nails of the recipient excluded a recipient‐related iciHHV‐6A. Viral loads > 7 log10 copies/10 6 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV‐6A strains are proof of donor‐related transmission. Detection of noncoding HHV‐6 snc‐RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV‐6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV‐6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis. Abstract : This report describes the diagnostic work‐up that evidences donor‐to‐recipient transmission and subsequent reactivation of inherited, chromosomally integrated HHV‐6A that led to the death of a kidney transplant recipient.