Infectious Disease Issues in Organ Transplantation

Guest Editor: Atul Humar

This virtual issue brings together a collection of papers in the field of transplant infectious diseases (ID). These include original manuscripts published in AJT as well as recent Minireviews. Transplant ID has witnessed significant advances in the last decade. These have occurred in all areas and encompass basic, translational and clinical research. Morbidity and mortality from certain infections (e.g. cytomegalovirus [CMV]) have decreased significantly although new challenges continuously arise. The selected articles highlight some of the recent advances in transplant ID. For example, molecular diagnostic techniques have revolutionized our approach to common pathogens in transplant recipients and are routinely employed in strategies for the diagnosis, prevention and treatment of common viral pathogens such as CMV and Epstein–Barr virus (EBV). The modern immunosuppression era has also witnessed the emergence of new pathogens and disease entities such as BK virus–associated nephropathy. Transplant programs have readily adapted to these new threats by adopting novel screening and prevention strategies. The changing global epidemiology of infections including the geographic spread of infections (e.g. West Nile virus), the emergence of novel respiratory viruses (novel H1N1 influenza), and others have highlighted the unique susceptibility of transplant recipients to emerging pathogens. It has also become clear that prevention and treatment strategies for common pathogens and disease entities must evolve to match changes in immunosuppression. Despite advances, there is always room for much more progress in a number of areas of transplant ID including donor-derived infections and fungal disease, as well as in the search for new therapies for viruses such as BK virus, EBV, and others. The papers selected here highlight some recent important developments, clinical trials, and reviews published in AJT. We have focused primarily on clinical and translational findings that have direct relevance to the care of the transplant patient.

Almyroudis NG, Sutton DA, Linden P, Rinaldi MG, Fung J, Kusne S. Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature. 2006; 6: 2365–2374.

Åsberg A, Humar A, Jardine AG, et al. Long-term outcomes of CMV disease treatment with vaganciclovir versus IV ganciclovir in solid organ transplant recipients. Am J Transplant 2009; 9: 1205–1213.

Åsberg A, Humar A, Rollag H, et al. Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant 2007; 7: 2106–2113.

Avery RK and Michaels M. Updated on immunizations in solid organ transplant recipients: What clinicians need to know. Am J Transplant 2008; 8: 9–14.

Brennan DC, Agha I, Bohl DL, et al. Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction. Am J Transplant 2005; 5: 582–594.

Carter JT, Melcher ML, Carlson LL, Roland ME, Stock PG. Thymoglobulin-associated Cd4+ T-cell depletion and infection risk in HIV-infected renal transplant recipients. Am J Transplant 2006; 6: 753–760.

Funch DP, Walker AM, Schneider G, Ziyadeh NJ, Pescovitz MD. Ganciclovir and acyclovir reduce the risk of post-transplant lymphoproliferative disorder in renal transplant recipients. Am J Transplant 2005; 5: 2894–2900.

Ginevri F, Azzi A, Hirsch HH, et al. Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients. Am J Transplant 2007; 7: 2727–2735.

Husain S, Paterson DL, Studer S, et al. Voriconazole prophylaxis in lung transplant recipients. Am J Transplant 2006; 6: 3008–3016.

Khoury JA, Storch GA, Bohl DL, et al. Prophylactic versus preemptive oral valganciclovir for the management of cytomegalovirus infection in adult renal transplant recipients. Am J Transplant 2006; 6: 2134–2143.

Kliem V, Fricke L, Wollbrink T, Burg M, Radermacher J, Rohde F. Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: Results of a randomized clinical trial. Am J Transplant 2008; 8: 975–983.

Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL. Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs. Am J Transplant 2009; 9: 620–628.

Kumar D, Chernenko S, Moussa G, et al. Cell-mediated immunity to predict cytomegalovirus disease in high-risk solid organ transplant recipients. Am J Transplant 2009; 9: 1214–1222.

Kumar D and Humar A. Pandemic influenza and its implications for transplantation. Am J Transplant 2006; 6: 1512–1517.

Kumar D, Welsh B, Siegal D, Hong Chen M, Humar A. Immunogenicity of pneumococcal vaccine in renal transplant recipients—three year follow-up of a randomized trial. Am J Transplant 2007; 7: 633–638.

Miller GG and Dummer JS. Herpes simplex and varicella zoster viruses: Forgotten but not gone. Am J Transplant 2007; 7: 741–747.

Nebbia G, Mattes FM, Smith C, et al. Polyfunctional cytomegalovirus-specific CD4+ and pp65 CD8+ T cells protect against high-level replication after liver transplantation. Am J Transplant 2008; 8: 2590–2599.

Nelson Kotton C, Ryan ET, Fishman JA. Prevention of infection in adult travelers after solid organ transplantation. 2005; 5: 8–14.

Pang XL, Fox JD, Fenton JM, Miller GG, Caliendo AM, Preiksaitis JK. Interlaboratory comparison of cytomegalovirus viral load assays. Am J Transplant 2009; 9: 258–268.

Preiksaitis JK, Pang XL, Fox JD, et al. Interlaboratory comparison of Epstein-Barr virus viral load assays. Am J Transplant 2009; 9: 269–279.

Randhawa P and Brennan DC. BK virus infection in transplant recipients: An overview and update. Am J Transplant 2006; 6: 2000–2005.

Roland ME, Barin B, Carlson L, et al. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. Am J Transplant 2008; 8: 255–365.

Schweitzer EJ, Perencevich EN, Philosophe B, Bartlett ST. Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection. Am J Transplant 2007; 7: 1515–1525.

Scharpé J, Evenepoel P, Maes B, et al. Influenza vaccination is efficacious and safe in renal transplant recipients. Am J Transplant 2008; 8: 332–337.

Smith F, Panek R, Kiberd BA. Screening to prevent polyoma virus nephropathy in kidney transplantation: A cost analysis. Am J Transplant 2009; 9: 2177–2179.

Snow AL and Martinez OM. Epstein-Barr virus: Evasive maneuvers in the development of PTLD. Am J Transplant 2007; 7: 217–277.

Vaudry W, Ettenger R, Jara P, et al. Valganciclovir dosing according to body surface area and renal function in pediatric solid organ transplant recipients. Am J Transplant 2009; 9: 636–643.

Wadei HM, Rule AD, Lewin M, et al. Kidney transplant function and histological clearance of virus following diagnosis of polyomavirus-associated nephropathy (PVAN). Am J Transplant 2006; 6: 1025–1032.

Watt K, Veldt B, Charlton M. A practical guide to the management of HCV infection following liver transplantation. Am J Transplant 2009; 9: 1707–1713.

Virtual Issue compiled online 4 Jan 2010.