Human herpesvirus-6 in liver transplant recipients - role in pathogenesis of fungal infections, neurologic complications, and outcome

Background. The clinical impact and relevance of human herpesvirus-6 (HHV-6 ) infection in liver transplant recipients, has not been fully discerned. Methods. A prospective study of 80 consecutive liver transplant recipients was performed using surveillance cultures for HHV-6 at weeks 2, 3, 4, and 6 after transplantation. Viral isolation was used for the detection of HHV-6 . Results. HHV-6 infection occurred in 39% (31 of 80) of the patients. Patien ts with HHV-6 infection were more likely to have hepatocellular carcinoma a s underlying liver disease (P=.09). Mental status changes of unidentifiable etiology were significantly more likely to occur in patients with HHV-6 co mpared with those without (26%, 9 of 31 vs. 6%, 3 of 49, P=.008). HHV-6 inf ection was an independent predictor of invasive fungal. infections (odds ra tio 8.3, 95% confidence interval, 1.2-58.0, P=.03). A significant associati on between HHV-6 infection and CMV infection after transplantation, CMV rec ipient and donor serostatus, rejection, or fever of unknown origin, could n ot be documented. Mortality at last follow-up in patients with HHV-6 infect ion (29%, 9 of 31) was significantly greater than those without HHV-6 (6%, 3 of 49, P=.008). Conclusions. Central nervous system complications of unknown etiology after liver transplantation may be related to HHV-6 infection. HHV-6 viremia was an independently significant predictor of invasive fungal infections and w as associated with late mortality in liver transplantation recipients.