Prevention of viral infections in solid organ transplant recipients in the era of COVID-19: a narrative review

ABSTRACT

Introduction

In solid organ transplant (SOT) recipients, viral infections are associated with direct morbidity and mortality and may influence long-term allograft outcomes. Prevention of viral infections by vaccination, antiviral prophylaxis, and behavioral measures is therefore of paramount importance.

Areas covered

We searched Pubmed to select publications to review current preventive strategies against the most important viral infections in SOT recipients, including SARS-CoV-2, influenza, CMV, and other herpesvirus, viral hepatitis, measles, mumps, rubella, and BK virus.

Expert opinion

The clinical significance of the reduced humoral response following mRNA SARS-CoV-2 vaccines in SOT recipients still needs to be better clarified, in particular with regard to the vaccines’ efficacy in preventing severe disease. Although a third dose improves immunogenicity and is already integrated into routine practice in several countries, further research is still needed to explore additional interventions. In the upcoming years, further data are expected to better delineate the role of virus-specific cell mediated immune monitoring for the prevention of CMV and potentially other viral diseases, and the role of the letermovir in the prevention of CMV in SOT recipients. Future studies including clinical endpoints will hopefully facilitate the integration of successful new influenza vaccination strategies into clinical practice.

KEYWORDS:

• Antivirals
• preemptive treatment
• prevention
• prophylaxis
• solid organ transplant
• vaccine
• viral infection

ARTICLE HIGHLIGHTS

• The clinical consequences of the reduced humoral immune response to SARS-CoV-2 vaccines in SOT recipients needs to be further investigated.

• Administration of a third SARS-CoV-2 vaccine dose has been shown to improve immunogenicity, but no clinical endpoints nor additional interventions have been studied to date.

• Preemptive administration of valganciclovir has been shown to be superior to universal prophylaxis for the prevention of CMV disease in D+/R-liver transplant recipients, although similar data are not available for recipients of other organs.

• Results from clinical trials are needed to allow the monitoring of CMV-specific cell-mediated immunity to be translated into routine clinical practice.

• Recent data suggest that subunit herpes zoster vaccine is safe and elicits appropriate immunogenicity in SOT recipients.

Declaration of interests

O Manuel received consulting fees from Gilead and honoraria from MSD both paid to his institution and unrelated to this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors have substantially contributed to the conception and design of the review article and interpreting the relevant literature and been involved in writing the review article or revised it for intellectual content.

Additional information

Funding

This paper was not funded.