RESUMEN
BACKGROUND: Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction. OBJECTIVE: The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections. METHODS: Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection. RESULTS: IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5. CONCLUSIONS: HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.
Asunto(s)
Infecciones Bacterianas/etiología , Coinfección , Infecciones por Citomegalovirus/complicaciones , Citomegalovirus/patogenicidad , Rechazo de Injerto/etiología , Herpesvirus Humano 6/patogenicidad , Trasplante de Hígado/efectos adversos , Infecciones por Roseolovirus/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anticuerpos Antivirales/sangre , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/microbiología , Biopsia , Distribución de Chi-Cuadrado , Citomegalovirus/genética , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/virología , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/inmunología , Rechazo de Injerto/virología , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/inmunología , Humanos , Trasplante de Hígado/inmunología , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/inmunología , Infecciones por Roseolovirus/virología , Factores de Tiempo , Resultado del Tratamiento , Carga Viral , Activación Viral , Latencia del Virus , Adulto JovenRESUMEN
The synthesis of two protected large peptides 1--45, and 46--86 covering the entire amino acid sequence of human proinsulin is described. Peptide 1--45, was synthesized from two intermediate fragments 1--23 and 24--45 and purified by countercurrent distribution in dimethylformamide system (K = 0.5). Peptide 46--86 was synthesized from two intermediate fragments 46--70 and 71--86 and purified by countercurrent distribution in two solvent systems, the dimethylformamide system (K = 0.06), and the toluene system (K = 0.16).