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dc.contributor.authorLindahl, Jenny
dc.date.accessioned2019-10-21T14:40:07Z
dc.date.available2019-10-21T14:40:07Z
dc.date.issued2019-10-21
dc.identifier.isbn978-91-7833-570-1 (PRINT)
dc.identifier.isbn978-91-7833-571-8 (PDF)
dc.identifier.urihttp://hdl.handle.net/2077/60790
dc.description.abstractAbstract Herpesvirus infections are common and can cause serious and life-threatening conditions in transplanted individuals. In this thesis, consisting of 4 papers (I-IV), we investigated primary infection and reactivation of Cytomegalovirus (CMV), Human Herpesvirus type 6 (HHV-6), Varicella Zoster Virus (VZV) and Epstein-Barr Virus (EBV) in transplant patients. The overall aim was to expand our knowledge on the incidence, prophylaxis, management and long-term effects of herpesvirus infections after transplantation. The studies were all retrospective. Results from serum and whole blood analyses by quantitative polymerase chain reaction (PCR) for CMV and HHV-6 in a cohort of 97 adult allo-SCT patients (papers I and II) and CMV and EBV in 58 renal transplanted children (paper IV) were compiled. VZV antibodies were analyzed using ELISA assays and immunofluorescence from blood samples of 85 renal transplanted children (paper III). In paper I, patients with CMV DNAemia had improved survival compared to CMV negative patients. There was an increased risk of CMV DNAemia with a seronegative donor to a seropositive recipient. CMV disease with debut more than 110 days after transplantation was related to steroid treatment for Graft versus Host Disease (GVHD).The morbidity associated with HHV-6 DNAemia following allo-SCT was in most cases mild. The overall one-year survival among the patients with HHV-6 DNAemia was not significantly different from the HHV-6 negative patients (paper II). At renal transplantation, protective VZV antibody-levels were less frequent and of lower magnitude in varicella-vaccinated children than in those with previous varicella. Vaccinated patients then lost their seropositivity to a greater extent than previously infected individuals. Herpes zoster was only seen in previously infected children (paper III). Long-lasting chronic high EBV load carriage (CHL) was seen in 24% of the renal transplant patients despite reduced immunosuppression. CHL carriage mainly developed in younger children. None developed post-transplant lymphoproliferative disorder (PTLD) during the median follow up of almost 8 years (paper IV). To conclude, the incidence of herpesvirus DNAemia is high after transplantation. VZV-vaccination and antiviral prophylaxis against CMV and VZV as well as pre-emptive CMV treatment and surveillance of EBV DNA are life-saving and reduces the long-term effects of herpesvirus infections.sv
dc.language.isoengsv
dc.relation.haspartI. Lindahl J, Woxenius S, Brune M, Andersson, R. Cytomegalovirus DNAemia and treatment following allogeneic stem cell transplantation with focus on long-term outcome. Scandinavian Journal of Infectious Diseases 2010; 42(9): 691-698. ::doi::10.3109/00365541003777114sv
dc.relation.haspartII. Lindahl J, Woxenius S, Brune M, Andersson R. Human herpesvirus type 6 DNAemia and infection following allogeneic stem cell transplantation with focus on long-term outcome. Scandinavian Journal of Infectious Diseases 2013, 45(7): 557-61. ::doi::10.3109/00365548.2013.773069sv
dc.relation.haspartIII. Lindahl J, Friman V, Westphal Ladfors S, Hansson S, Andersson, R, Jertborn M, Woxenius S. Long-term study showed that vaccination protected paediatric renal transplant recipients from life-threatening varicella zoster virus. Acta Paediatrica 2018, Dec;107(12):2185-2192. Epub 2018 May 25. ::doi::10.1111/apa.14375sv
dc.relation.haspartIV. *Westphal Ladfors S, *Lindahl J, Hansson S, Brandström P, Andersson R, Jertborn M, Lindh M, Woxenius S, Friman V. Long lasting chronic high load carriage of Epstein-Barr virus is more common in young pediatric renal transplant recipients. Accepted in Pediatric Nephrology, 2019. * contributed equally to this work ::doi::10.1007/s00467-019-04401-9sv
dc.subjectAllogeneic stem cell transplantationsv
dc.subjectCytomegalovirussv
dc.subjectEpstein-Barr virussv
dc.subjectHuman Herpesvirus type 6sv
dc.subjectRenal transplantationsv
dc.subjectVaricella zoster virussv
dc.titleHerpesvirus infections in transplant recipientssv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailjenny.lindahl@vgregion.sesv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.adminPaper IV: Long lasting chronic high load carriage of Epstein-Barr virus is more common in young pediatric renal transplant recipients is accepted for publication in Pediatric Neprology 2019.sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInstitute of Biomedicine. Department of Infectious Diseasessv
dc.gup.defenceplaceTorsdagen den 14 november 2019, kl. 13.00, Föreläsningssalen, Infektionskliniken, Diagnosvägen 21, Sahlgrenska universitetssjukhuset/Östra sjukhuset, Göteborgsv
dc.gup.defencedate2019-11-14
dc.gup.dissdb-fakultetSA


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