Association of HHV-6 With Outcomes in CMV-seronegative Liver Transplant Recipients With CMV-seropositive Donors Receiving Preemptive Antiviral Therapy
| Autor: | Nina Singh, Meei Li Huang, Raymund R. Razonable, Marilyn M. Wagener, G. Marshall Lyon, Fernanda P. Silveira, Drew J. Winston, Ajit P. Limaye, Keith R. Jerome |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Herpesvirus 6 Human Cytomegalovirus Viremia Antiviral Agents Gastroenterology law.invention Randomized controlled trial law Internal medicine Humans Medicine Ganciclovir Transplantation business.industry Area under the curve virus diseases Valganciclovir medicine.disease Transplant Recipients Liver Transplantation Real-time polymerase chain reaction Cytomegalovirus Infections Population study business Viral load medicine.drug |
| Zdroj: | Transplantation. 105:2427-2434 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003604 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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