Respiratory Viruses: Influenza, RSV, and Adenovirus in Kidney Transplantation

Abstract

Although advances in immunosuppression and antimicrobial prophylaxis have led to improved patient and graft survival, respiratory viruses continue to be a common cause of morbidity and mortality in immunocompromised populations. We describe the clinical manifestations, diagnosis and treatment options for influenza, respiratory syncytial virus and adenovirus infection in the kidney transplant population.

Vaccination Practices in Pediatric Dialysis Patients Across Europe. A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group Study

“…Most guidelines do not recommend live virus vaccines after RTx. However, 2 studies on live virus vaccination (varicella and measles) after RTx did not show any complications attributable to the vaccine except 1 out of 17 children with mild vaccination varicella [15, 16]. Despite these encouraging reports, live vaccines should better be administered before RTx.…”

Ten tips to manage renal transplant recipients

“…Rates of severe CMV disease have decreased owing to post-transplant prophylaxis and pre-emptive treatment strategies. Several other respiratory viruses (influenza respiratory syncytial virus, or adenovirus) may, however, cause severe viral pneumonia [2]. BK polyomavirus may reactivate in immunocompromised patients and lead to nephritis, ureteral stenosis, and less frequently haemorrhagic cystitis.…”

Viruses in transplantology

“…According to the Polish National Hygiene Institute, the incidence rate of influenza in Poland is 8000 to 10 000 per 100 000 population, with the mortality below 0.5% The annual incidence of influenza in transplant recipients is 1% to 4%. 47 The clinical symptoms manifest after an incubation period of 1 to 3 days. However, the infection can be transmitted onto others from even 1 day before the onset of clinical symptoms until day 3 to 5 of the disease, or even for several weeks in immunocompromised individuals.…”

“…When drug resistance is confirmed, treatment should be converted into one of acceptable efficacy. 47 The need to ensure safety of immunocompromised patients obligates transplant centers to undertake actions aiming at limiting influenza virus transmission at peak season. As part of such actions, all transplant procedures should be temporarily suspended, and the patients admitted for diagnostic assessment or as elective admission-discharged.…”