02120nas a2200217   4500008003900000245013600039210006900175260000800244300000700252490000700259520146600266100001701732700001301749700001301762700001301775700002401788700001501812700001201827700001401839856004901853       2020                          d00aEvaluation of liver failure in a pediatric transplant recipient of a liver allograft with inherited chromosomally integrated HHV-6B0 aEvaluation of liver failure in a pediatric transplant recipient   cFeb  a410 v923 aBackground: Active infections of human herpesvirus 6B (HHV-6B) are frequent in immunocompromised recipients after transplantation. Nevertheless, they need to be distinguished from latent inherited chromosomally integrated genomes (iciHHV-6) present in about 1% of the population to avoid unnecessary administration of toxic antivirals.

Methods: A 5-year-old child presented with acute liver allograft rejection associated with HHV-6 DNA in plasma, which led to an unfavorable outcome. We investigated the possibility of HHV-6 infection derived from an iciHHV-6 present in the donor's liver using molecular and histopathology studies in various tissues, including quantification of HHV-6 DNA, genotyping, sequencing for antiviral resistance genes, relative quantification of viral transcripts, and detection of gB and gH viral proteins.

Results: The presence of iciHHV-6B was evidenced in the donor with signs of reactivation in the gallbladder and transplanted liver (detection of HHV-6B mRNA and late proteins). This localized expression could have played a role in liver rejection. Low viral loads in the recipient's plasma, with identical partial U39 sequences, were in favor of viral DNA released from the transplanted liver rather than a systemic infection.

Conclusions: Determination of iciHHV-6 status before transplantation should be considered to guide clinical decisions, such as antiviral prophylaxis, viral load monitoring, and antiviral therapy.1 aBonnafous, P1 aPhan, TL1 aHimes, R1 aEldin, K1 aGautheret-Dejean, A1 aPrusty, BK1 aAgut, H1 aMunoz, FM  uhttps://www.notifylibrary.org/reference/5124