@article {5124,
	title = {Evaluation of liver failure in a pediatric transplant recipient of a liver allograft with inherited chromosomally integrated HHV-6B},
	volume = {92},
	year = {2020},
	month = {Feb},
	pages = {41},
	abstract = {Background: 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{\textquoteright}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{\textquoteright}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.},
	doi = {10.1002/jmv.25600},
	author = {Bonnafous, P and Phan, TL and Himes, R and Eldin, K and Gautheret-Dejean, A and Prusty, BK and Agut, H and Munoz, FM}
}
