Viral infections in pediatric solid organ transplantation recipients and the impact of molecular diagnostic testing

The review highlights advances in the diagnosis and treatment of viral infections in organ transplant recipients, with emphasis on the most significant pathogens for liver transplant recipients.

The development of molecular diagnostics has markedly improved the ability to rapidly identify infections in transplantation patients and has improved clinical care. Multiplex polymerase chain reaction (PCR) has enhanced the ability to identify respiratory viruses, permitting earlier treatment. Monitoring for cytomegalovirus and Epstein-Barr virus by PCR offers the opportunity for preemptive interventions. However, imperfect negative predictive values may result in failure to treat early disease, and poor positive predictive values may lead to increased risk of rejection in patients in whom immunosuppression is prematurely reduced and/or unnecessary administration of antiviral therapy. For several viral pathogens, there is an absence of specific and well tolerated therapies, and several treatment modalities have not been rigorously evaluated in controlled clinical trials.

Viral infections remain a leading cause of morbidity and mortality in the solid organ transplantation population, particularly in pediatric patients. Whereas diagnostic testing has greatly improved, there is an urgent need for the development of novel therapies, including adoptive immunotherapy, to provide well tolerated and effective therapy.