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Nephrology Dialysis Transplantation 2007 22(Supplement 8):viii72-viii82; doi:10.1093/ndt/gfm648
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cytomegalovirus and polyomavirus BK posttransplant

Adrian Egli1, Simone Binggeli1, Sohrab Bodaghi1, Alexis Dumoulin1, Georg A. Funk1, Nina Khanna1,2, David Leuenberger1, Rainer Gosert1 and Hans H. Hirsch1,2

1Transplantation Virology, Institute for Medical Microbiology, Department Clinical & Biological Sciences, University of Basel, Switzerland and 2Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland

Correspondence to: Hans H. Hirsch, MD, MSc Transplantation Virology, Institute for Medical Microbiology, Department of Clinical & Biological Sciences, Petersplatz 10, CH-4003 Basel, Switzerland. Email: Hans.Hirsch{at}unibas.ch



  Abstract

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


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