Antiviral Stewardship in Transplantation

Area of Science:

• Infectious Diseases
• Transplant Medicine
• Pharmacology

Background:

• Antimicrobial stewardship programs (ASPs) are hospital mandates, yet transplant recipient involvement is limited.
• Optimal antiviral stewardship (AVS) practices for transplant patients remain undefined.
• Viral infections pose significant risks, including morbidity and mortality, in transplant recipients.

Purpose of the Study:

• To review and highlight opportunities for antiviral stewardship (AVS) in transplant recipients.
• To address the specific challenges of managing viral infections in this population.
• To provide insights into AVS for various viruses relevant to transplant care.

Main Methods:

• Literature review focusing on antiviral stewardship interventions.
• Analysis of AVS strategies for cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), varicella-zoster virus (VZV), SARS-CoV-2, respiratory syncytial virus, and BK polyomavirus.
• Examination of clinical syndromes, diagnostics, resistance, and economic factors in AVS.

Main Results:

• Identified specific AVS opportunities for multiple viruses in transplant patients.
• Highlighted the importance of AVS due to high risks associated with viral infections.
• Discussed challenges including drug toxicities and resistance.

Conclusions:

• Antiviral stewardship is essential for optimizing care and outcomes in transplant recipients.
• Targeted AVS interventions can mitigate the impact of viral infections.
• Further research and implementation of AVS protocols are needed for this patient group.