AbstractsBiology & Animal Science

CMV-, EBV-, and HHV-6-DNAemia after liver transplantation

by Raisa Loginov




Institution: University of Helsinki
Department: Department of Biological and Environmental Sciences, General Microbiology; Transplant Unit Research Laboratory, Transplantation and Liver Surgery Clinic, Department of Surgery, Helsinki University Hospital and University of Helsinki;Department of Virology
Year: 2007
Keywords: yleinen mikrobiologia
Record ID: 1144288
Full text PDF: http://hdl.handle.net/10138/22444


Abstract

Viral infections caused by herpesviruses are common complications after organ transplantation and they are associated with substantial morbidity and even mortality. Herpesviruses remain in a latent state in a host after primary infection and may reactivate later. CMV infection is the most important viral infection after liver transplantation. Less is known about the significance of human herpesvirus-6 (HHV-6). EBV is believed to play a major role in the development of post-transplant lymphoproliferative disorders (PTLD). The aim of this study was to investigate the CMV-, EBV- and HHV-6 DNAemia after liver transplantation by frequent monitoring of adult liver transplant patients. The presence of CMV, EBV and HHV-6 DNA were demonstrated by in situ hybridization assays and by real-time PCR methods from peripheral blood specimens. CMV and HHV-6 antigens were demonstrated by antigenemia assays and compared to the viral DNAemia. The response to antiviral therapy was also investigated. CMV-DNAemia appeared earlier than CMV pp65-antigenemia after liver transplantation. CMV infections were treated with ganciclovir. However, most of the treated patients demonstrated persistence of CMV-DNA for up to several months. Continuous CMV-DNA expression of peripheral blood leukocytes showed that the virus is not eliminated by ganciclovir and recurrences can be expected during several months after liver transplantation. HHV-6 DNAemia / antigenemia was common and occurred usually within the first three months after liver transplantation together with CMV. The HHV-6 DNA expression in peripheral blood mononuclear cells correlated well with HHV-6 antigenemia. Antiviral treatment significantly decreased the number of HHV-6 DNA positive cells, demonstrating the response to ganciclovir treatment. Clinically silent EBV reactivations with low viral loads were relatively common after liver transplantation. These EBV-DNAemias usually appeared within the first three months after liver transplantation together with betaherpesviruses (CMV, HHV-6, HHV-7). One patient developed high EBV viral loads and developed PTLD. These results indicate that frequent monitoring of EBV-DNA levels can be useful to detect liver transplant patients at risk of developing PTLD. Herpesvirusinfektiot aiheuttavat merkittäviä komplikaatioita ja jopa kuolleisuutta elinsiirtopotilailla. Herpesviruksille tyypillinen piirre on, että ne jäävät primaari-infektion jälkeen elimistöön piilevinä ja reaktivoituvat myöhemmin. Sytomegalovirus (CMV) infektio on kliinisesti tärkein maksansiirron jälkeen esiintyvä virusinfektio. Vähemmän tiedetään human herpesvirus-6:n (HHV-6) uusintainfektioista ja niiden merkityksestä elinsiirtojen jälkeen. Epstein-Barrin virus (EBV) voi aiheuttaa siirron jälkeisen lymfoproliferatiivisen tilan (PTLD). Tämän väitöskirjatutkimuksen tarkoituksena oli tutkia CMV-, EBV- ja HHV-6- DNA:n esiintymistä potilaan perifeerisessä veressä maksansiirron jälkeen. Tutkimuksen aineisto koostui aikuisista maksansiirtopotilaista, joita monitoroitiin…