Donor‐derived fulminant herpes simplex virus hepatitis after liver transplantation: Two cases and review of literature

• Published in: Transplant infectious disease 2023-08, Vol.25 (4), p.e14080-n/a
• Main Authors: Reinhold, Ilana, Teasca, Laurent, Rodriguez, Elena Requejo, Berney, Thierry, Mueller, Nicolas J, Hilty, Matthias, Andermatt, Rea, Saro, Francesca, Dutkowski, Philipp, Müllhaupt, Beat, Delden, Christian
• Format: Article
• Language: English
• Subjects: Cytomegalovirus; Disease prevention; donor‐derived infection; guidelines; Hepatitis; Hepatitis A; Herpes simplex; Herpes Simplex - diagnosis; Herpes Simplex - drug therapy; herpes simplex virus; Herpes viruses; Humans; Infectious diseases; Intraabdominal Infections; Literature reviews; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Prophylaxis; Retrospective Studies; Serology; Simplexvirus; Tissue Donors; Transplantation; Transplants & implants; Viruses
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.14080

Background Fulminant herpetic hepatitis due to herpes simplex virus (HSV), serotype 1 or 2, is a rare but often fatal complication after solid organ transplantation (SOT). HSV hepatitis in SOT recipients can occur either due to primary infection acquired post transplantation, viral reactivation in a seropositive patient, or as donor‐derived infection. Cases of fatal hepatitis have been reported in the liver as well as in other SOT recipients. The fatal outcome is mostly due to delayed diagnosis and treatment, which is explained by the lack of clinical specificity of HSV hepatitis. Methods We report two cases of fatal donor‐derived HSV hepatitis in liver‐transplanted recipients. We reviewed all published cases of donor‐derived HSV infections after SOT with an evaluation of the presence of prophylaxis and outcome. Results In both liver recipients, the retrospective determination of HSV serostatus was negative, and both cases occurred in the absence of cytomegalovirus or HSV prophylaxis. A review of the literature showed a significant series of cases of severe hepatitis, mostly fatal, as well as the absence of specific preventive therapy guidelines in cases of HSV serology mismatch. Conclusions The occurrence of two fatal donor‐derived hepatitis made the Swiss Transplant Infectious Diseases working group modify its national recommendations regarding pretransplant serostatus determination and HSV prophylaxis after liver transplantation. Further studies are needed to assess this approach. Two fatal cases of donor‐derived herpes simplex virus (HSV) infections after liver transplantation (LT) modified the Swiss recommendations for HSV prophylaxis: In case of lacking cytomegalovirus prophylaxis, HSV prophylaxis is initiated in individuals with an HSV D+/R− constellation after LT.