Viral Infection in the Renal Transplant Recipient

Abstract

Viruses are among the most common causes of opportunistic infection after transplantation and the most important. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Viral infection, both symptomatic and asymptomatic, causes the "direct effects" of invasive disease and "indirect effects," including immune suppression predisposing to other opportunistic infections and oncogenesis. Rapid and sensitive microbiologic assays for many of the common viruses after transplantation have replaced, for the most part, serologic testing and in vitro cultures for the diagnosis of infection. Furthermore, quantitative molecular tests allow the individualization of antiviral therapies for prevention and treatment of infection. This advance is most prominent in the management of cytomegalovirus, Epstein-Barr, hepatitis B, and hepatitis C viruses. Diagnostic advances have not been accompanied by the development of specific and nontoxic anti-viral agents or effective antiviral vaccines. Vaccines, where available, should be given to patients as early as possible and well in advance of transplantation to optimize the immune response. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections.

Viral infection and reactivation in autoimmune disease

“…A well-recognized complication of cytotoxic or immunosuppressive therapy is the reactivation of pathogenic viruses that have remained latent in the host following primary infection (1,2). Immunosuppression may also render patients more vulnerable to new viral infections.…”

Mucormycosis of the Transplanted Kidney With Renal Papillary Necrosis

“…23 Apart from the direct effects of invasive disease, cytomegalovirus produces immunomodulatory effects, resulting in further immunosuppression and an increased risk of other opportunistic infections after transplant. 24 We conclude that renal allograft mucormycosis is a serious condition requiring early suspicion and recognition of the condition, and its aggressive management with surgery and antifungal medication.…”

Prevalence of cytomegalovirus and BK polyoma virus infection in post-renal transplant patients in a tertiary care centre in

“…All the patients in our study have received ganciclovir prophylaxis for CMV for a period of three months. Prophylaxis has been shown to be effective in reducing the incidence of CMV disease (17). There was a statistical significance between pre-transplant diabetes and CMV infection in the allograft recipients.…”