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Infections and solid organ transplant rejection: a cause-and-effect relationship?
Francesca Cainelli1, Sandro Vento
1Section of Infectious Diseases, Department of Pathology, University of Verona, Verona, Italy. francescacainelli@yahoo.it
The Lancet. Infectious Diseases
|September 11, 2002
Summary
Infections like cytomegalovirus (CMV) may trigger transplant rejection. Antiviral treatments for CMV do not prevent rejection, highlighting the need for new strategies like vaccination.
Area of Science:
- Transplant Immunology
- Infectious Diseases
- Virology
Background:
- Emerging evidence suggests infections can precipitate transplant rejection.
- Specific viral infections are implicated in various graft failure types.
Purpose of the Study:
- To review the evidence linking viral infections to allograft rejection.
- To evaluate the efficacy of current antiviral therapies in preventing rejection.
- To propose future research and therapeutic directions.
Main Methods:
- Systematic review of studies on viral infections and transplant rejection.
- Analysis of associations between specific viruses (CMV, adenovirus, enterovirus, parvovirus, HSV, HHV-6) and rejection.
- Evaluation of antiviral prophylaxis and pre-emptive treatment outcomes.
Main Results:
- Viral infections, including cytomegalovirus (CMV), are linked to cardiac, kidney, lung, and liver allograft rejection.
- Current antiviral treatments for CMV do not effectively prevent immune-mediated graft rejection or post-transplantation atherosclerosis.
- Human herpesvirus 6 reactivation is associated with CMV disease in kidney and liver recipients.
Conclusions:
- Prospective, international studies are crucial to elucidate the role of infections in transplant rejection.
- Future strategies should explore virus-virus interactions and novel therapies beyond antivirals, including vaccination and immunomodulation (e.g., natural killer cell inhibition).
- Current antiviral strategies are insufficient to mitigate the risk of allograft rejection.