Journal Article

Cytomegalovirus and polyomavirus BK posttransplant

Adrian Egli, Simone Binggeli, Sohrab Bodaghi, Alexis Dumoulin, Georg A. Funk, Nina Khanna, David Leuenberger, Rainer Gosert and Hans H. Hirsch

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 22, issue suppl_8, pages viii72-viii82
Published in print September 2007 | ISSN: 0931-0509
Published online September 2007 | e-ISSN: 1460-2385 | DOI: https://dx.doi.org/10.1093/ndt/gfm648
Cytomegalovirus and polyomavirus BK posttransplant

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Virus replication and progression to disease in transplant patients is determined by patient-, graft- and virus-specific factors. This complex interaction is modulated by the net state of immunosuppression and its impact on virus-specific cellular immunity. Due to the increasing potency of immunosuppressive regimens, graft rejections have decreased, but susceptibility to infections has increased. Therefore, cytomegalovirus (CMV) remains the most important viral pathogen posttransplant despite availability of effective antiviral drugs and validated strategies for prophylactic, preemptive and therapeutic intervention. CMV replication can affect almost every organ system, with frequent recurrences and increasing rates of antiviral resistance. Together with indirect long-term effects, CMV significantly reduces graft and patient survival after solid organ and hematopoietic stem cell transplantation. The human polyomavirus called BK virus (BKV), on the other hand, only recently surfaced as pathogen with organ tropism largely limited to the reno-urinary tract, manifesting as polyomavirus-associated nephropathy in kidney transplant and hemorrhagic cystitis in hematopoetic stem cell transplant patients. No licensed anti-polyoma viral drugs are available, and treatment relies mainly on improving immune functions to regain control over BKV replication. In this review, we discuss diagnostic and therapeutic aspects of CMV and BKV replication and disease posttransplantation.

Keywords: cytomegalovirus; BK virus; prophylaxis; resistance; T-cells; transplantation; viral infections

Journal Article.  6497 words.  Illustrated.

Subjects: Nephrology

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