Human Herpesvirus 6, 7, And 8 In Solid Organ Transplantation

Serological studies for HHV‐6 and HHV‐7 are not recommended in the evaluation of solid organ transplant (SOT) candidates or recipients. (Low, Strong)

Culture, while highly specific for active infection, is not widely available and is not routinely recommended. (Low, Strong)

For suspected HHV‐6 disease, tissue biopsy may be performed where possible to confirm the diagnosis or rule out other etiologies. (Low, Weak)

Detection of viral nucleic acid by quantitative polymerase chain reaction (PCR) in blood or CSF is the preferred method for diagnosis of HHV‐6 and HHV‐7 infection and is recommended over antigenemia assays. (Moderate, Strong)

Viral nucleic acid may also be detected from bronchoalveolar lavage fluid and tissue by PCR and may be informative performed in the appropriate clinical context. (Low, Weak)

Diagnostic testing for HHV‐6 or HHV‐7 should be limited to scenarios where symptomatic infection is plausible, as detection of viral nucleic acid or antigen may be insufficient evidence of disease in the absence of clinically compatible symptoms. (Moderate, Strong)

CIHHV6 should be a consideration in individuals with persistent, high‐grade DNAemia and may be diagnosed by serial monitoring of viral load by PCR of whole blood or peripheral blood mononuclear cells (PBMC) or by droplet digital PCR. (Low, Strong)

The majority of HHV‐6 and HHV‐7 infections are asymptomatic, transient, and do not require antiviral treatment. (Moderate, Strong)

Antiviral treatment with foscarnet, ganciclovir, or cidofovir should be initiated in the setting of HHV‐6 encephalitis. (Moderate, Strong)

Treatment should be considered for other syndromes attributable to HHV‐6 or HHV‐7. (Low, Weak)

Especially in cases of moderate or severe disease, antiviral treatment may be complemented by reduction of immunosuppression. (Low, Strong)

Antiviral prophylaxis and preemptive antiviral therapy for HHV‐6 or HHV‐7 infections are not recommended after transplant. (Low, Strong)

Routine monitoring for HHV‐6 and HHV‐7 infections after SOT is not recommended. (Low, Strong)