Lee, S.‐O.

AbstractBackgroundToll‐like receptor 3 (TLR3) is implicated in the pathogenesis of viral diseases owing to its ability to recognize viral double‐stranded RNA. We hypothesized that single nucleotide polymorphism (SNP) in TLR3 gene that impairs the function of the protein‐receptor influences the outcome of hepatitis C virus (HCV) infection after liver transplantation.MethodsThe clinical characteristics of 611 liver recipients (HCV‐infected: n = 153, non‐HCV‐infected: n = 458) were assessed to investigate the impact of TLR3 L412F SNP on transplant outcomes.ResultsTLR3 L412F is common, and it was significantly more prevalent among the HCV‐infected cohort (57.5% vs. 45.2%, P = 0.008). In a multivariate analysis, TLR3 L412F was significantly associated with chronic hepatitis C (odds ratio: 1.73, 95% confidence interval [CI]: 1.13–2.65, P = 0.01). In an analysis that compared HCV‐infected patients with wild‐type versus TLR3 L412F, a marginally higher rate of allograft failure and mortality was observed in the TLR3 L412F group (44.3% vs. 30.8%, P = 0.09). However, in a multivariate analysis, only donor age was significantly associated with allograft failure and mortality (relative risk: 1.04, 95% CI: 1.007–1.06, P = 0.02).ConclusionTLR3 L412F is significantly common in HCV‐infected liver recipients, and may be associated with worse outcomes. However, larger studies are needed to determine its significant association with allograft failure and mortality after liver transplantation for chronic hepatitis C.

AbstractHuman herpesvirus‐6 (HHV‐6) is unique among human herpesviruses because of its ability to integrate into chromosomes. This entity, termed chromosomally integrated HHV‐6 (CIHHV‐6), is often mistaken for active infection and treated unnecessarily. The clinical significance of CIHHV‐6 in transplant recipients is not defined. Herein, the clinical characteristics of 7 liver transplant patients with CIHHV‐6 from our recent study, together with 14 other published cases of CIHHV‐6 were reviewed. Of the 21 cases, CIHHV‐6B was reported most commonly among solid organ transplant recipients, while CIHHV‐6A was mostly seen in allogeneic hematopoietic stem cell recipients. None of the 21 patients developed clinical symptoms related to HHV‐6 after transplantation. However, antiviral therapy was administered to 5 asymptomatic patients mistaken to have HHV‐6 infection because of their very high HHV‐6 DNA levels, 3 who developed symptomatic cytomegalovirus disease, and 1 with graft‐versus‐host disease that was mistaken for HHV‐6 infection. In patients who received antiviral therapy, there was no apparent decline in HHV‐6 DNA load, although change in viral kinetics is difficult to discern in the setting of high baseline HHV‐6 DNA load. Clinicians should be aware of this entity of CIHHV‐6 so that antiviral therapy can be considered in the proper clinical context.