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Chapter 6 : Viral Infections in Organ Transplant Recipients

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Viral Infections in Organ Transplant Recipients, Page 1 of 2

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Abstract:

Solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) represent continually expanding fields of medicine, and, with many innovative methods for allograft management, new and unusual presentations of virus infections continue to occur. These new drugs or modalities aim to protect the SOT recipient from rejection of the newly acquired organ by the endogenous immune system or to protect the recipient from attack by the graft (Graft vs. Host Disease, GVHD). For example, in the mid-1960s, with the introduction of cytotoxic drugs such as azathioprine and cyclophosphamide in renal transplantation, pneumonitis associated with human cytomegalovirus (CMV) infection was first observed (1). Soon thereafter, it was noted that transplant recipients with Epstein-Barr virus (EBV) infection developed a previously unrecognized clinical syndrome, posttransplantation lymphoproliferative syndrome (PTLD) (2). In populations with a high prevalence of human herpesvirus 8 (HHV-8) infection, Kaposi sarcoma became a problem following SOT (3). With time, most of the endogenous herpesviruses and polyomaviruses of humans have emerged as particular problems. At the same time, respiratory viruses and hepatitis viruses complicate successful management of the SOT and HCT recipient as methods of iatrogenic immunosuppression change. The donor tissue itself can be the source of transmission of virus infection, including rabies (4), West Nile virus (5), human T leukemia virus type I (6), human immunodeficiency virus (7), lymphocytic choriomeningitis virus (8), and B19 parvovirus (9).

Citation: Zaia J. 2017. Viral Infections in Organ Transplant Recipients, p 75-98. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch6
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FIGURE 1

Occurrence of the most frequent virus infections after transplantation. The time after both solid organ and marrow transplantation correlates with characteristic types of virus infections, ranging from herpes simplex virus (HSV) at the earliest time, to cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpesvirus type 6 (HHV-6), and herpesvirus type 8 (HHV-8) at 1 to 3 months after transplantation and with adenovirus, varicella zoster virus (VZV), polyomavirus, and hepatitis viruses at later times.

Citation: Zaia J. 2017. Viral Infections in Organ Transplant Recipients, p 75-98. In Richman D, Whitley R, Hayden F (ed), Clinical Virology, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819439.ch6
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