β-herpesvirus activation after kidney transplantation with mycophenolate mofetil–based maintenance immunosuppression

Donor Infection: An Opinion on Lung Donor Utilization

“…All herpesviruses be transmitted either by the allograft or by transfusion of blood or blood components. 38,39 Seroconversion or DNA detection after transplantation (Tx) is equated with transmission of the virus in most instances. Furthermore, especially with regard to the newly recognized human herpesviruses (HHV 6 -8), most studies have explored reactivation without differentiating between transmitted or endogenous reactivation.…”

Unusual presentation of herpes virus infections in renal transplant recipients exposed to high mycophenolic acid plasma concentrations

“…With the introduction of MMF in renal transplantation a reduced incidence of early acute rejection has been achieved. In contrast to the three so‐called pivotal trials, in which the use of MMF was not associated with an increase in the incidence of viral infections (11–14), several authors have reported more CMV disease (15, 16) or more tissue invasive CMV disease in MMF‐treated allograft recipients (3, 17, 18). One study suggests that MMF might contribute to insufficient ganciclovir CMV prophylaxis with incomplete CMV eradication (19).…”

Detection of Different Virus-Specific CD8+ T Cells after Kidney Transplantation

“…Immunosuppression and the underlying disease are major risk factors for the reactivation of latent CMV and de novo viral infection. Thus, for example, the inhibition of lymphocyte proliferation by immunosuppressive drugs correlates with the development of active CMV disease in transplant patients, and can be observed in up to 75% of patients depending on the immunosuppressive regimen that is being used [28][29][30][31][32][33]. These observations have been confirmed with the clinical use of antilymphocyte therapy such as anti-thymocyte globulin (ATG) or muromonab-CT3 (OKT3), as well as of pulsed steroids, for the prevention and treatment of graft rejection [34].…”