Impact of SARS-CoV-2 Infection on Reactivation of Herpesviridae after Heart and Heart and Kidney Transplantation.

Immunosuppression after Heart transplantation (HTx) carries a life-long risk for infection and reactivation of herpesviridae. Especially changes in the immunosuppressive therapy regime can promote viral reactivation. Infections with SARS-CoV-2 can also alter the immune response. However, potential effects on herpesviridae reactivation still needs to be examined in this context. Since emerge of the COVID-19 pandemic in the early 2020, n=61 of our HTx or heart and kidney transplant (HKTx) patients had positive polymerase chain reaction (PCR) for SARS-CoV-2. Relevant patient data including results for potential concomitant herpes simplex virus (HSV-1, HSV-2), cytomegalovirus (CMV), Epstein-Barr-virus (EBV), varicella zoster virus (CZV) and human herpesvirus-8 (HHV-8) DNAemia were retrospectively reviewed in September 2022 to evaluate its clinical impact. Most patients have received at least one and up to six doses of COVID-19 vaccine before contracting SARS-CoV-2. In general, HTx and HKTx patients developed symptomatic but mild COVID-19, which was most likely caused by any kind of omicron subvariant. SARS-CoV-2 positive HTx and HKTx patients were pharmacologically treated for COVID-19. DNAemia of herpesviridae was examined in about one third of the patients (n=20). HSV-1 DNAemia was confirmed in 6.25% of tested patients with a maximum viral load of 1,130,000 HSV-1-DNA copies/µg-DNA. In not a single patient HSV-2, VZV and HHV-8 DNA was found. In contrast, CMV was observed in 20% of tested patients with a maximum of 195 CMV-DNA copies/µg-DNA and EBV in 23.5% (maximum 1230 EBV-DNA copies/µg-DNA). In one patient simultaneous CMV- and EBV-DNAemia and in another patient EBV- and HSV-1-DNAemia were found. Nevertheless, none of these patients developed clinically relevant infection or reactivation of herpesviridae and therefore no targeted treatment was initiated. Recently, SARS-CoV-2 infections are commonly observed in patients after HTx and HKTx. Fortunately, patients rarely suffer from severe COVID-19-related symptoms. Meanwhile, concomitant infections or reactivation of herpesviridae, especially CMV and EBV, are regularly observed. Although we did not overserved CMV or EBV disease, regularly testing for herpesviridae seems reasonable in these patients. [ABSTRACT FROM AUTHOR]