Emerging viral diseases in kidney transplant recipients

Abstract

Viruses are the most important cause of infections and a major source of mortality in Kidney Transplant Recipients (KTRs). These patients may acquire viral infections through exogenous routes including community exposure, donor organs, and blood products or by endogenous reactivation of latent viruses. Beside major opportunistic infections due to CMV and EBV and viral hepatitis B and C, several viral diseases have recently emerged in KTRs. New medical practices or technologies, implementation of new diagnostic tools, and improved medical information have contributed to the emergence of these viral diseases in this special population. The purpose of this review is to summarize the current knowledge on emerging viral diseases and newly discovered viruses in KTRs over the last two decades. We identified viruses in the field of KT that had shown the greatest increase in numbers of citations in the NCBI PubMed database. BKV was the most cited in the literature and linked to an emerging disease that represents a great clinical concern in KTRs. HHV-8, PVB19, WNV, JCV, H1N1 influenza virus A, HEV, and GB virus were the main other emerging viruses. Excluding HHV8, newly discovered viruses have been infrequently linked to clinical diseases in KTRs. Nonetheless, pathogenicity can emerge long after the discovery of the causative agent, as has been the case for BKV. Overall, antiviral treatments are very limited, and reducing immunosuppressive therapy remains the cornerstone of management.

Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation

“…However, the immunosuppressive therapy necessary for graft survival increases the risk of opportunistic viral infections, mainly by persistent viral infections such as those promoted by the Herpesviridae family. In special, Epstein‐Barr virus (EBV), human cytomegalovirus (HCMV), and human herpesvirus type 6 (HHV‐6) are of interest since they may be related to severe post‐transplant complications …”

Human Cytomegalovirus Inhibits Autophagy of Renal Tubular Epithelial Cells and Promotes Cellular Enlargement

“…However, post-transplant immunosuppressive drugs is inevitably associated with opportunistic viral infections, mainly by persistent viruses such as the members of the Herpesviridae family. Especially, HCMV, Epstein–Barr virus (EBV) and human herpesvirus type 6 (HHV-6) are of interest, since they can cause severe post-transplant complications (Moal et al, 2013 ). Antiviral agents are recommanded to prevent the viral multiplication and the appearance of clinical diseases, but they are unable to eradicate these viruses.…”

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

“…Although it is beyond the scope of this article to cover all infectious complications, the applications of IHC will be highlighted, most notably in staining for viral pathogens, with current caveats. 103,104 Organisms may be few and present in a patchy distribution; thus, the absence of a positive IHC result or a demonstrable organism does not entirely rule out infection, given the possibility of false-negative sampling. Conversely, although rare, more than one organism or pathologic process may coexist ( Figure 3, A through C).…”