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Adverse Occurrence type:
Although seroprevalence may be high in certain age groups, as a neurotropic virus, transmission via solid organ transplantation is uncommon.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
A 64-year-old male patient underwent liver transplantation for non-alcoholic steato-hepatitis cirrhosis. The donor was a 22-year-old man who died from a gunshot trauma. His past medical history was unremarkable and no clinical manifestation of herpes simplex was noted. CMV status D-/R-, with no requirement for prophylaxis according to protocol in use. On postoperative day (POD) 9, the recipient developed abdominal pain and fever of 39.2°C. Liver enzymes were slightly elevated. Lymphopaenia and worsening liver function ensued, with encephalopathy. Liver biopsy on POD 11 showed histological and immunocytochemistry features of HSV hepatitis. IV acyclovir (10 mg/kg IV every 8 h) was started. HSV 1 was isolated from liver tissue. Two weeks post commencement of high dose IV ACV, HSV 1 DNA continued to be positive by PCR in CSF and serum. The recipient also developed disseminated aspergillosis and died 4 weeks post transplantation.
Demonstration of imputability or root cause:
Retrospective testing of donor serum demonstrated HSV 1 seropositivity; recipient was negative for HSV 1 and 2 antibodies when tested on POD 9 and went on to develop systemic primary HSV 1 infection with first symptoms noted on POD 9 and confirmed diagnosis on POD 11. The authors did not mention other recipients and did not look for presence of detectable virus or HSV IgM in the donor. However with a seropositive donor and diagnosis of primary HSV 1 infection in the early post transplant period, it is quite probable that the infection was acquired via the transplanted organ. Coincidental primary infection acquired from another source cannot be ruled out.
Suggest new keywords:
hepatitis; encephalitis; primary infection; HSV antibodies; herpes simplex; liver transplant
Herpes simplex hepatitis after liver transplantation: case report and literature review. Cote-Daigneault J et al. Transpl Infect Dis. 16(1):130-4, 2014 Feb.
Expert comments for publication:
HSV is a neurotropic virus that establishes latency in ganglia but it is theoretically possible that low level asymptomatic viraemia occurs under certain conditions; another possibility posed by others is the presence of the virus in autonomic plexus. Outside the neonatal period and the immunocompromised host population, HSV viraemia is rare but has been documented in intensive care unit patients.