Human herpesvirus 6 seronegativity before transplantation predicts the occurrence of fungal infection in liver transplant recipients

Background Invasive fungal infection has a major impact on the morbidity an d mortality of liver transplant recipients. Human herpesvirus (HHV)-6 infec tion after transplantation is associated with an immunosuppressive state an d the development of cytomegalovirus disease. Because cytomegalovirus infec tion is a risk factor for invasive fungal infection after transplantation, we have examined whether HHV-6 and fungal infection are associated after tr ansplantation. Methods. Pretransplantation sera from 247 consecutive liver transplant reci pients were analyzed for IgG to HHV-6, Thirty-three (13%) HHV-6-seronegativ e recipients were identified. Six of 33 (18%) seronegative recipients exper ienced fungal infection as compared with 15 of 214 (7%) seropositive recipi ents (P = 0.034), Results, In a univariate analysis of risk factors for fungal infection, pre transplantation seronegativity to HHV-6 (P = 0.034), intraoperative cryopre cipitate requirements greater than the 75th percentile (P = 0.035), reopera tion (P = 0.005), biliary stricturing postoperatively (P = 0.046), and gast rointestinal or vascular complications postoperatively (P = 0.030) were ide ntified as significant risk factors. Moreover, in pairwise multivariate ana lysis, pretransplantation HHV-6 seronegativity remained a significant varia ble even in the presence of each of the other variables. Conclusions. These results suggest that HHV-6 seronegativity before transpl antation is a valuable clinical marker that identifies patients at risk for developing fungal infection after transplantation.