title: Cytomegalovirus and polyomavirus BK posttransplant.
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.
authors: Transplantation Virology, Institute for Medical Microbiology, Department of Clinical & Biological Sciences, Petersplatz 10, CH-4003 Basel, Switzerland.
authors: Adrian
authors: A
authors: Egli
authors: Simone
authors: S
authors: Binggeli
authors: Sohrab
authors: S
authors: Bodaghi
authors: Alexis
authors: A
authors: Dumoulin
authors: Georg A
authors: GA
authors: Funk
authors: Nina
authors: N
authors: Khanna
authors: David
authors: D
authors: Leuenberger
authors: Rainer
authors: R
authors: Gosert
authors: Hans H
authors: HH
authors: Hirsch
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000378:metabolism*; D003587:Cytomegalovirus / Q000378:metabolism*; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000517:prevention & control; D000939:Epitopes / Q000737:chemistry; D006801:Humans; D007107:Immune System; D007371:Interferon-gamma / Q000378:metabolism; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008954:Models, Biological; D027601:Polyomavirus Infections / Q000209:etiology* / Q000517:prevention & control; D013601:T-Lymphocytes / Q000821:virology
chemical_list: D000998:Antiviral Agents; D000939:Epitopes; D007371:Interferon-gamma