Association of HHV-6 With Outcomes in CMV-seronegative Liver Transplant Recipients With CMV-seropositive Donors Receiving Preemptive Antiviral Therapy. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Singh, Nina; Winston, Drew J.; Razonable, Raymund R.; Lyon, G. Marshall; Huang, Meei-Li; Jerome, Keith R.; Silveira, Fernanda P.; Wagener, Marilyn M.; Limaye, Ajit P.
• Is Part Of: Transplantation. Volume 105:Issue 11(2021)
• Publication Date: 2021-11
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000003604
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Risk factors, virological parameters, and outcomes associated with HHV-6 viremia in high-risk donor CMV-seropositive and recipient CMV-seronegative (D+R–) liver transplant recipients in the current era are incompletely defined. Methods: The study population consisted of patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus valganciclovir prophylaxis for CMV prevention in D+R– liver transplant recipients. Weekly blood samples through 100 d in the PET group were tested for HHV-6 viremia using a real-time quantitative polymerase chain reaction. Assessments included virological characteristics and relationship with CMV, risk factors, and impact of HHV-6 viremia with outcomes through 12 mo posttransplant. Results: HHV-6 viremia at any level developed in 42% (40 of 96). Older patient age ( P = 0.03), longer hospitalization ( P = 0.015), and ICU stay at transplantation ( P = 0.029) were significantly associated with high-grade viremia. Concurrent HHV-6 and CMV viremia was associated with earlier onset of HHV-6 viremia ( P = 0.004), higher HHV-6 area under the curve ( P = 0.043), and higher peak HHV-6 viral load ( P = 0.006) versus HHV-6 viremia alone. High-grade viremia was independently associated with biopsy-proven rejection within 12 mo ( P = 0.045) posttransplant. Conclusions: Among D+R– liver transplant recipients receiving valganciclovir as PET, high-grade HHV-6 viremia was associated with increased age and critical illness in ICU at time of transplant and was independently associated with allograft rejection.