Update on Prevention, Detection, and Management of Viral Infections in the Renal Transplant Recipient

Despite progress in preventing and controlling infectious complications of renal transplantation, posttransplantation viral infections remain a significant threat to patients’ health. Optimizing outcomes after renal transplantation depends on effective management of posttransplant infectious complications. This paper discusses manifestations, prevention, diagnosis, and treatment of common viral complications of renal transplantation. Preventive therapy and prompt diagnosis remain the cornerstones of effective control of viral infections in the renal transplant recipient. Measures to prevent and control posttransplantation viral infections include careful screening of recipients and donors for infectious disease, meticulous postoperative care, prophylactic antiviral therapy, judicious use of immunosuppression, efficient use of laboratory and other diagnostic tests for specific diagnosis, and treatment targeted at causative pathogens. (Adv Stud Med. 2007;7(13):401-410) A lthough infectious complications of renal transplantation are less common and cause less morbidity and mortality today than during the initial decades after the advent of renal transplantation, they remain a significant threat to the health of renal transplant recipients. Infections are associated with organ rejection and can be caused by viruses, bacteria, fungi, or protozoa. Of the infectious diseases, those caused by viruses cause significant morbidity and mortality in renal transplant recipients. These viruses are immunosuppressive as well as oncogenic, and they also may induce kidney graft dysfunction. The renal transplant patient is vulnerable both to pathogens and—because of the patient’s immunosuppressed status—to viruses that typically would not cause disease in healthy individuals. Optimizing outcomes after renal transplantation depends on prevention, diagnosis, and effective management of transplantation-associated viral infections. This paper discusses manifestations, prevention, diagnosis, and management of common viral infectious complications of renal transplantation. IMMUNOSUPPRESSIVE STATUS AND INFECTION AFTER RENAL TRANSPLANTATION The immunosuppressed status of the renal transplant recipient increases the vulnerability to viral infection, including that caused by organisms that typically do not cause disease in healthy individuals. The degree of immunosuppression depends on numerous factors (Table 1). The main immunosuppressive therapies used in renal transplant recipients include corticosteroids, calUPDATE ON PREVENTION, DETECTION, AND MANAGEMENT OF VIRAL INFECTIONS IN THE RENAL TRANSPLANT RECIPIENT