Unveiling the Viral Challenges: A 5-Year Review of Infections in Solid-Organ Transplant Patients

Solid-organ transplant recipients are prone to infections due to intensive immunosuppression treatments after transplant. Incidence of viral infections is gradually increasing. During the COVID-19 pandemic, transplant patients were shown to be at increased risk of infections. We investigated viral infections in transplant patients before and during the pandemic to guide patient follow-up.

We collected data of solid-organ transplant recipients ≥18 years old who experienced viral infections during 2019-2023. We analyzed demographic data, transplant types, and clinical outcomes with SPSS software (version 25.0); P < .05 was statistically significant.

We analyzed 238 patients (mean age 43.9 ± 14.9 years; 69.7% male) diagnosed with viral infections: 79.8% received kidney transplants, 16.4% liver, and 3.8% heart. The most prevalent virus was SARS-CoV-2 (64.7%), followed by influenza (18.1%) and cytomegalovirus (7.6%). Mean age for heart transplant was lower than among other transplant types (P = .015). Fever, cough, and sputum production were common in influenza infections (P = .012, P = .041, and P = .009, respectively); myalgia and dyspnea were common with SARS-CoV-2 (P = .029 and P = .013, respectively). Rates of bacteremia and intensive care unit admission were high for cytomegalovirus infections (P = .002, P = .031). Thrombocytopenia and bacteremia were detected more frequently for liver transplants (P = .004 and P = .013, respectively). Empirical antibiotic treatment was started in 17.2% of patients. Twenty-nine patients were monitored in the intensive care unit, and 12.1% died. Mortality was significantly higher in patients >65 years old and in the presence of bacteremia (P = .001).

Vaccination, early detection, and preventive strategies play pivotal roles to manage viral infections in solid-organ transplant recipients. Future research should focus on optimized prophylaxis and individualized care plans.