Table 1.
Common viral pathogens in renal transplant recipients, time of their presentation, prevalence, prevention and available cures.
| Common viral pathogens in renal transplant recipients | Time of their presentation | Prevalence in renal transplant population | Prevention | Therapy and available cures |
|---|---|---|---|---|
| Cytomegalovirus | Months 3–12 Months 1–3 (in absence of prophylaxis) Beyond 1 year (in setting of extended prophylaxis) |
8–32% | Serologic screening for antibody donor and recipient, universal prophylaxis include acyclovir, ganciclovir, valacyclovir, valganciclovir, and immune globulin preparations | Combination of immunomodulation, antiviral therapy (intravenous ganciclovir, valganciclovir, foscarnet, cidofovir, and leflunomide) and reduction of immunosuppression |
| Herpes simplex | First Month, Months 1–3 | approximately 53% | Serologic screening for antibody donor and recipient | Acyclovir |
| Varicella zoster | Months 1–6 | 4–12% | Serologic screening for antibody donor and recipient, live attenuated varicella vaccine | Ganciclovir, valacyclovir, acyclovir |
| Epstein-Barr virus | Months 1–12 | 1–3% | EBV load testing is commonly used | Reduction of immunosuppression, infusing donor lymphocytes, infusing EBV-specific cytotoxic T and infusing anti-CD20 monoclonal antibody |
| Human herpesvirus-6 | First Month, Months 1–3 | No data | Serologic screening for antibody donor and recipient | Reduction of immunosuppression, ganciclovir, cidofovir, foscarnet |
| Human herpesvirus-7 | First Month and Months 1–3 | No data | Serologic screening for antibody donor and recipient | Reduction of immunosuppression, ganciclovir, cidofovir, foscarnet |
| Human herpesvirus-8 | Months 6–12 and beyond 1 year | 0.2–5% | Optional screening measures | Reduction of immunosuppression, rapamycin |
| Polyomavirus BK/JC | Months 3–12 and beyond 1 year | 1%–10% | Quantitative nucleic acid-based viral load assay of urine or blood, urine cytology, polymerase chain reaction | Reduction of immunosuppression, cidofovir, leflunomide, quinolones, and intravenous immunoglobulin |
| Hepatitis B and C (acquisition of new infection) | Months 1–12 and beyond 1 year | No data | Serologic screening for antibody donor and recipient | Reduction of immunosuppression lamivudine, adefovir, and entecavir |
| Hepatitis B and C (reactivation) | First Month, Months 1–3 | 2–10% | Serologic screening for antibody donor and recipient | Interferon (associated with an increased risk of allograft rejection) |
| Human immunodeficiency virus | No data | No data | Serologic screening for antibody donor and recipient | The optimal management of immunosuppression in HIV infected individuals remains unknow |
| Adenovirus, respiratory, syncytial virus, influenza, parainfluenza, human metapneumovirus, rhinovirus, and coronavirus | Months 1–12 and beyond 1 year | No data | Influenza vaccine | Oseltamivir, zanamavir, ribavirin, cidofovir |
| West Nile virus (acquisition from transplant) | First Month | No data | Optional Screening Measures | Reduction of immunosuppression |
| West Nile virus (acquired after transplant) | Months 1–12 and beyond 1 year | No data | Optional Screening Measures | Reduction of immunosuppression |