Pharmacotherapy of post-transplant viral infections

Abstract

Background: Management of a number of significant viral pathogens in transplant recipients remains challenging. Objectives: To define an optimal antiviral approach to the management of cytomegalovirus (CMV), human herpes virus-6 (HHV-6), Epstein–Barr (EBV)-associated post-transplant lymphoproliferative disorder (PTLD), and polyoma virus-associated nephropathy in transplant recipients. Methods: Clinical trials and existing data regarding use of antiviral agents for these viruses were reviewed to develop evidence-based recommendations for their management. Conclusions: Weighing the current evidence regarding the use of valganciclovir as pre-emptive therapy or prophylaxis, the former approach offers a greater benefit for the overall prevention of CMV disease. Limited data show that prophylaxis with antiviral agents is associated with a reduction in the risk of EBV-associated PTLD. Treatment options for HHV-6 and polyoma virus-associated nephropathy are still limited.

Keywords::

• cidofovir
• cytomegalovirus
• Epstein–Barr virus
• foscarnet
• antiviral ganciclovir
• human herpes virus-6
• leflunomide
• maribavir
• polyoma virus nephropathy
• post-transplant lymphoproliferative disorder
• rituximab
• transplants
• valganciclovir