[Viral infections after transplantation].
Determinants of the host (quality and quantity of immune effectors, underlying disease, age), of the graft (organ type, HLA-mismatching, injury, permissiveness for virus infection) and of the virus (genus, organ tropism, fitness, antiviral resistance) define the risk of viral infection, morbidity and mortality in organ transplantation. This "menage-à-trois" of host, graft and virus is influenced by dose- or magnitude-dependent factors denoted modulators such as type and dose of immunosuppression, the degree of local and systemic inflammatory patterns well as use of immunoglobulins or antivirals. The most advanced concepts have been established for infections with cytomegalovirus (CMV). Three elements have been driving this progress: 1. Clinical-virological definitions of infection and disease; 2. quantitative viral assays in clinically relevant turn-around time; 3. effective antiviral agents. Further impact may be come from characterising the specific cellular immunity. The broader availability of quantitative assays based on real-time PCR can be expected to improve the diagnosis of "new" viruses of relevance in transplantation such as Epstein-Barr virus, polyomavirus BK, and viruses targeting the respiratory tract.
Hirsch
H H
HH
Abteilung für Infektiologie am Kantonsspital Basel und Transplantations-Virologie am Institut für Medizinische Mikrobiologie, Universität Basel. hans.hirsch@unibas.ch
D000998:Antiviral Agents / Q000627:therapeutic use; D006801:Humans; D007108:Immune Tolerance; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D016133:Polymerase Chain Reaction; D011379:Prognosis; D015996:Survival Rate; D014181:Transplantation Immunology / Q000276:immunology*; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology
D000998:Antiviral Agents