Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein-Barr virus, BK virus, adenovirus and other viral reactivations in transplantation

Sim, BZ; Yong, KY; Slavin, MA; Yong, MK

Author(s): Sim, BZ; Yong, KY; Slavin, MA; Yong, MK;
Details: Publication Year 2022-12,Volume 35,Issue #6,Page 536-544
Journal Title: Current Opinion in Infectious Diseases
Publication Type: Review
Abstract: PURPOSE OF REVIEW: Reactivation of viral infections occurs frequently in immunosuppressed populations, particularly in solid organ (SOT) or allogeneic haematopoietic cell (HCT) transplant patients. Concurrent and sequential multivirus infections are common, yet risk factors and outcomes remain unclear. This review aims to identify the patients vulnerable to multivirus infections and characterize the impact of increased viral burden to formulate prevention and treatment strategies. RECENT FINDINGS: Incidences of up to 89% in SOT and 36% in HCT have been reported for two viruses, and 32% in SOT and 28% in HCT for at least three viruses. Risk factors appear related to an increased burden of immunosuppression, with most viral coinfections occurring within 12 months of transplantation. Direct viral complications such as cytomegalovirus disease are more frequent in coinfected patients, with documented prolonged duration of viraemia, higher viral load and increased end-organ disease. Graft dysfunction, acute rejection and graft-vs.-host disease (GVHD) have also been associated. Increased mortality is reported in the HCT population. SUMMARY: Multivirus infections occur in a significant proportion of transplant patients and is linked to immunosuppressive burden. There is increasing evidence that this leads to worse graft and patient outcomes. Further prospective studies are required to further comprehensively characterise viral epidemiology, mechanisms and treatment strategies to ameliorate this risk.
Keywords: Humans; Cytomegalovirus; *BK Virus; Herpesvirus 4, Human; Adenoviridae; *Epstein-Barr Virus Infections/etiology; *Adenoviridae Infections/etiology; *Graft vs Host Disease; *Hematopoietic Stem Cell Transplantation/adverse effects; Risk Factors
Department(s): Infectious Diseases
PubMed ID: 36255049
Publisher's Version: https://doi.org/10.1097/QCO.0000000000000888
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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