Donor Transmission of Chromosomally Integrated Human Herpes Virus-6 with Fatal Outcome

Human herpes virus-6 (HHV-6) is a common cause of childhood febrile illness. In solid organ transplant recipients, HHV-6 frequently reactivates, but clinical disease is rare. In less than 1% of all people, HHV-6 is chromosomally integrated (CI-HHV-6) and transmitted from parent to child (Nephrol Dial Transplant 2011; 26:2391). CI-HHV-6 rarely leads to posttransplant disease.

Now, investigators report a donor with CI-HHV-6A transmitting fatal disease to a liver recipient. The recipient developed diarrhea and confusion 23 days posttransplant and progressed to pancytopenia, encephalopathy, septic physiology, and death at day 98. Treatment with ganciclovir and foscarnet combined with reduction in immunosuppression was ineffective. High levels of…