Adem KÖSE, Sibel ALTUNIŞIK TOPLU, Fatih GÖNÜLTAŞ, Cemalettin KOÇ, Yusuf YAKUPOĞULLARI, Barış OTLU, Emine TÜRKMEN SAMDANCI, Şeyma YAŞAR, Sezai YILMAZ, Yaşar BAYINDIR

Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimiClinical presentation, diagnosis and management of herpes simplex virus viremia in liver transplant recipients

Amaç: Karaciğer nakli (LT) alıcılarında, Sitomegalovirüs (CMV) profilaksisine rağmen nakil sonrası dönemde gelişen Herpes simpleks virüsü (HSV) viremisinin klinik varyasyonlarını, olası risk faktörlerini, tanı prosedürlerini ve sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler:1100 karaciğer nakli alıcısının verileri geriye dönük olarak değerlendirildi. Çalışmaya aktif ağrılı mukokutanöz veziküler lezyonları olan hastaların kan ve veziküler sıvı örneklerinde saptanan HSV DNA RT-PCR ve doku biyopsisi yapılan ile HSV viremisi doğrulanan ve organ tutulumu bulguları olan hastalar dahil edildi. HSV viremisi tanısı alan 110 karaciğer nakli alıcısı tespit edildi. Bulgular:110 alıcıda altmış ay boyunca toplam 130 HSV viremi atağı gözlendi. HSV viremisi oranı %11,8 idi. 130 HSV atağının 120'si (%92,3) hastalığın mukokutanöz formu idi. 10 olguda spesifik bir organ tutulumu vardı. Tüm viremi ataklarında HSV-1 saptandı. Karaciğer naklinden altı ay sonra 64 (%49,2) atak gelişti, Karaciğer nakli sonrası birinci ve altıncı aylar arasında 41 (%31,5) atak gelişti ve postoperatif ilk ayda 25 (%20,3) atak gözlendi. Tüm ataklar farklı antiviral tedavi yöntemleri ile başarılı bir şekilde tedavi edildi. Sonuç: Yapılan CMV profilaksisine rağmen, HSV viremisi, karaciğer nakli alıcılarında geniş bir klinik yelpazede ortaya çıkabilir. Serum örneklerinden alınan HSV DNA RT-PCR'ın viremi tanısı için her zaman yeterli olmayabilir, bu nedenle tanıyı desteklemek için veziküler sıvının analizi veya organlardan biyopsi yapılması gerekebilir.

Anahtar Kelimeler:

liver transplantation, recipients, herpes simplex virus, viremia, acyclovir

Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimi

Aim: We aimed to evaluate the clinical variations, possible risk factors and results of diagnostic procedures in liver transplant (LT) recipients who suffered from Herpes Simplex Virus (HSV) viremia in the post-transplant period, despite Cytomegalovirus (CMV) prophylaxis. Material and methods: The data of 1100 LT recipients were evaluated retrospectively. HSV DNA RT-PCR detected in blood and vesicular fluid samples of the patients with active painful mucocutaneous vesicular lesions and patients with organ involvement who had biopsy and confirmed HSV viremia were included in the study. The 110 recipients diagnosed with HSV viremia were included. Results: In 110 recipients, total 130 HSV viremia episodes were observed over sixty months. HSV viremia rate was 11.8%. Of the 130 HSV episodes, 120 (92.3%) were mucocutaneous form of the disease. In 10 cases, there was a specific organ involvement. HSV-1 was detected in all of viremia episodes. Sixty-four (49.2%) episodes developed six months after the LT, 41 (31.5%) episodes developed between the 1st and 6th months after LT, and 25 (20.3%) episodes were observed within the first postoperative month. All episodes were treated successfully with different antiviral therapy modalities. Conclusion: Despite CMV prophylaxis performed, HSV viremia may be occurred as a wide range of clinical presentation in LT recipients. It can be seen at any time point after the LT. HSV DNA RT-PCR from serum samples may not be sufficient for diagnosis of viremia, therefore the analysis of the vesicular fluid or the biopsy from the organs may be necessary for supporting the diagnosis.

Keywords:

Liver transplantation, recipients, herpes simplex virus, acyclovir,

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