Monitoring and managing viral infections in pediatric renal transplant recipients

Abstract

Viral infections remain a significant cause of morbidity and mortality following renal transplantation. The pediatric cohort is at high risk of developing virus-related complications due to immunological naiveté and the increased alloreactivity risk that requires maintaining a heavily immunosuppressive environment. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses may affect clinical outcome. Recent technological advances and novel antiviral therapy have allowed implementation of viral and immunological monitoring protocols and adoption of prophylactic or preemptive treatment approaches in high-risk groups. These strategies have led to improved viral infection management in the immunocompromised host, with significant impact on outcome. We review the major viral infections seen following kidney transplantation and discuss strategies for preventing and managing these pathogens.

Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation

“…In agreement with most of the reviewed literature, CMV represents the most frequent virus detected in transplanted patients (Comoli and Ginevri, 2012). Costa et al, have detected active infection by CMV in 43.3% of liver transplant recipients followed for one year, while HHV6 was detected in 40% (Costa et al, 2011).…”

Herpesviruses excretion in saliva of pediatric transplant recipients

“…In agreement with most of the reviewed literature, CMV was the most frequent virus detected in serum samples of transplanted patients . CMV was the major cause of morbidity, and other herpesvirus‐associated diseases were not found, despite the frequent detection of these viruses in saliva.…”

Renal transplantation in infants

“…Since most infants are seronegative for these viruses at the time of transplantation, primary infection after RTx is common. Monitoring of these viruses by a PCR method from blood or plasma samples is highly recommended [57]. CMV viremia is rare in patients receiving valganciclovir prophylaxis, but after stopping the medication, subclinical or clinical viremia is quite common.…”

“…In our center, PTLD has been diagnosed in seven of the 252 RTx patients (3.7 %) and four of these had received their kidney graft as infants. Excellent articles on the management of CMV, EBV, and PV infections have recently been published [57][58][59][60][61].…”