Background In recent years liver transplantation has become a well-accepted therapeutic modality for children with end stage liver disease and transplantation surgery is done in younger age. Despite the fact that primary infection with human herpes virus 6 (HHV-6) infects most children within the first two years of life, only scarce cases of primary HHV-6 infection in children after liver transplantation are reported.
Objective To describe cases of primary HHV-6 infection after pediatric liver transplantation.
Methods Medical files of pediatric patients after liver transplantation with suspected primary HHV-6 infection between the years 2015-2016 were reviewed. For enrolled cases, clinical, laboratory and medical treatment data were evaluated and medical history was reviewed.
Results Four cases of primary HHV-6 (type B) were identified among the 26 children who underwent liver transplantations at our center during the study period. All primary infections occurred in children who were transplanted below the age of one year. All patients presented with fever, hepatitis and elevated inflammatory markers in the short period after transplantation. All patients were initially treated with antibiotics in suspicion of bacterial infection and 3 children underwent a liver biopsy, only one showing signs of rejection. Three of the 4 patients were treated with antiviral therapy with gradual resolution of their symptoms.
Discussion Primary HHV-6 should be taken into account in young children shortly after liver transplantation, when representing with fever and elevated liver enzymes. Treatment with anti-viral therapy as well as consideration of decreasing the anti-rejection therapy is warranted.
