Reactivation of herpes simplex virus after liver transplantation

Reactivation of herpes simplex virus (HSV) after liver transplantation occurs but the incidence and clinical significance are unknown. We recruited 12 consecutive male patients listed for liver transplantation and positive for HSV antibody. HSV polymerase chain reaction was performed on mouth and penile swabs before and at days 5 and 10 after transplant. Data were recorded regarding clinical evidence of HSV infection, degree of immune suppression, length of intensive care stay, and use of antiviral agents. Five out of twelve patients (42%) had evidence of oral reactivation after transplant although only one had clinical manifestations. Genital reactivation was not seen. Reactivation did not correlate with immune suppression but duration of intensive care stay was a possible risk factor. Ganciclovir prescribed for cytomegalovirus prophylaxis in one patient was ineffective. Oral reactivation of HSV after liver transplantation is common; although clinical significance appears low in this small series, routine testing could be implemented readily.