Viral surveillance and subclinical viral infection in pediatric kidney transplantation

Abstract

The more potent immunosuppressive therapy that has successfully reduced the incidence of acute rejection and improved graft outcomes has also resulted in a higher incidence of viral complications. Sensitive molecular methods now allow for the detection of subclinical viral infection which is increasingly recognized due to the adoption of routine post-transplant viral surveillance protocols. The goal of viral surveillance is the detection of subclinical viral infection that triggers an intervention; one that either prevents progression to viral disease or leads to early diagnosis of viral disease which is associated with improved outcomes. Knowledge of the epidemiology and natural history of subclinical viral infection and disease, as well as patient specific risk factors, is required to establish the optimal surveillance schedule which achieves the goal of early diagnosis. Evidence that detection of subclinical viral infection can impact viral disease is variable depending on the virus. This review will summarize the current data on the role of viral surveillance for BK virus (BKV), cytomegalovirus (CMV) and Epstein Barr virus (EBV) in the pediatric kidney transplant population.

Renal transplantation in infants

“…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].…”

Impact of Everolimus and Low-Dose Cyclosporin on Cytomegalovirus Replication and Disease in Pediatric Renal Transplantation

“…We therefore pooled the data Defined as eGFR (28) at 30 days posttransplant. 3 Within the first year posttransplant. 4 Including borderline changes (Banff 97 '09 update [26,27] …”

“…Despite recent advances achieved in antiviral therapy, cytomegalovirus (CMV) remains the most important opportunistic infectious agent in transplant recipients, because CMV replication is associated with high morbidity, mortality, and diminished graft survival (1)(2)(3)(4)(5)(6)(7)(8)(9). Experimental data indicate that mammalian target of rapamycin inhibitors (mTORi) such as everolimus (EVR) and sirolimus (SRL) exhibit direct anti-CMV effects leading to reduced CMV replication (10)(11)(12)(13).…”

Infectious Diseases and the Kidney in Children

“…Experience with pediatric kidney transplant recipients suggests a 67 % incidence of CMV infection, with approximately 67 % being negative at the time of transplantation [115]. The direct and indirect effects of CMV infection result in a significant morbidity and mortality among kidney transplant recipients.…”

“…Oral valganciclovir is recommended for CMV prophylaxis posttransplant [118]. Duration of chemoprophylaxis is dependent on the serostatus of the donor and recipient [115]. While it is effective in reducing the incidence of symptomatic CMV, prospective viral surveillance studies have shown subclinical infection in 12-22 % of pediatric kidney transplant recipients, hence the importance of viral surveillance [115].…”