MANAGEMENT OF HERPES-SIMPLEX VIRUS TYPE-1 PNEUMONIA FOLLOWING LIVER-TRANSPLANTATION

Interstitial pneumonia caused by Herpes simplex virus type 1 (HSV-1) i s a severe complication of orthotopic liver transplantation (LTX). The records of patients were reviewed who had an LTX at the age of 16 yea rs or older between 1991 and 1994 with a mean follow-up of 21 months ( range, 10 to 44 months), Six patients were included who had fever of > 38 degrees C, deterioration of arterial blood gases, radiological evid ence of interstitial pneumonia and proof of HSV-1 in bronchoalveolar l avage fluid, All patients were anti-HSV-IgG positive before LTX, All p atients were successfully treated with intravenous acyclovir, mechanic al ventilation and reduced immunosuppression. Three patients who recei ved cyclosporin A had a rejection which was successfully treated by sw itching to FK 506, Four patients were discharged in good health, One p atient died 36 months after LTX of an unrelated cause. One patient die d of urosepsis on postoperative day 139. Acyclovir together with mecha nical ventilation and reduced immunosuppression proved to be an effect ive treatment for HSV-1 pneumonia following LTX.