DNA Viral Infections Complicating Lung Transplantation

Abstract

DNA viruses with potential to cause complications after lung transplantation include the human Herpesviridae family consisting of cytomegalovirus (CMV), herpes simplex virus 1 and 2 (HSV-1, -2), varicella-zoster virus (VZV), human herpesvirus 6, 7, and 8 (HHV-6, -7, -8), and Epstein-Barr virus (EBV); the Polyomaviridae family consisting of BK virus and JC virus; and the Adenoviridae family consisting of more than 50 adenovirus subtypes. This is a diverse group of viruses with equally diverse immediate and long-term impacts on allograft function and clinical outcomes following lung transplantation. This article discusses the individual pathogens, their epidemiology and clinical manifestations, as well as treatment and preventive strategies in this era of antiviral treatment regimens.

Viral Metagenomics Reveal Blooms of Anelloviruses in the Respiratory Tract of Lung Transplant Recipients

“…Long-term lung transplant outcomes have been linked to prior infection with several other viruses (1, 2, 4). While our subjects were sampled at relatively early time points (median 5 months post-transplant), early post-transplant colonization with other microbial agents has been associated with BOS at later time points (34, 35).…”

“…For the case of lung transplantation, viral infection is a major complicating factor impacting graft survival rates (1–4). Respiratory infections with known viruses can cause direct lung injury or increase risk of graft failure, as in the case of cytomegalovirus and community acquired respiratory viruses (1, 5).…”

Adenovirus Infections in Immunocompetent and Immunocompromised Patients

“…The occurrence of adenoviremia has been reported to be less than 10% of adult patients after kidney, heart, or liver transplantation; although the symptoms of HAdV infection are usually mild, and invasive infection does not correlate with organ rejection (157), severe and even fatal courses have also been described (158,159). Studies in patients undergoing lung transplantation showed that pulmonary infection with HAdV can correlate with significantly elevated rates of rejection, bronchiolitis obliterans, and mortality (160)(161)(162). In line with the epidemiology of HAdV infections, detection of this virus appears to be more common in pediatric SOT recipients (155,163), with reported rates of HAdV infection ranging from 3.5% to 38% after liver transplantation (164,165), from 7% to 50% after lung and heart transplantation (166)(167)(168), and from 4% to 57% after intestinal or multivisceral transplantation (169,170).…”

Herpesvirus Respiratory Infections in Immunocompromised Patients: Epidemiology, Management, and Outcomes

“…159,164 The immune response to EBV infection is mediated by NK cells and cytotoxic CD4 and CD8 T lymphocytes. 150,165 With anti-T cell immunosuppression after transplant, EBV-infected B lymphocytes can proliferate with impunity. The polyclonal proliferation may transform to monoclonal proliferation that develops into a lymphoma.…”