Viral Infection after Renal Transplantation

Abstract

Viral infections remain a significant cause of morbidity and mortality following renal transplantation. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or post transplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. This review will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens.

Common Infections in Kidney Transplant Recipients

“…If CMV disease worsens or the viral load increases despite 2 weeks of therapy, ganciclovir resistance should be considered (33). CMV resistance is usually attributed to prolonged exposure to subtherapeutic ganciclovir (especially with oral ganciclovir); however, recently Couzi et al found a higher incidence of drug resistance CMV (UL97 or UL54 mutation) in pre-emptively treated D+R2 kidney transplant recipients, demonstrating that resistance can be seen even in shorter exposures to ganciclovir and its analogues (34).…”

“…Currently there is no consensus regarding the treatment of PTLD, but reduction of immunosuppression is routinely used and can lead to remission in 23%-86% of patients (33). Although antiviral therapy has been used alone or with immunoglobulin, no evidence supports its efficacy (35).…”

“…Rituximab (monoclonal antibody to CD20) is commonly used to treat EBV-positive PTLD in patients requiring therapy beyond immunosuppression reduction (35). In some cases with persistent disease, PTLD isolated to the allograft may warrant surgical resection of the allograft (33). Chemotherapy should be administered in patients in whom rituximab fails, those with EBV-negative PTLD, and those requiring a rapid response (38).…”

“…Chemotherapy should be administered in patients in whom rituximab fails, those with EBV-negative PTLD, and those requiring a rapid response (38). In patients who achieve complete remission but lose their allograft, retransplantation has been successful (33). Patients with isolated allograft involvement have a 5-year survival rate of 68% compared with 36%-38% in kidney transplant recipients with PTLD extending beyond the allograft (33).…”

“…In patients who achieve complete remission but lose their allograft, retransplantation has been successful (33). Patients with isolated allograft involvement have a 5-year survival rate of 68% compared with 36%-38% in kidney transplant recipients with PTLD extending beyond the allograft (33).…”