Improving Long-term Outcomes in Kidney Transplantation: Post-transplant Viral Infections, Compliance (Adherence) and Tolerance Induction

By Dr. Abhinav Humar

Post-transplant viral infections include CMV, BKV, EBV, Influenza, COVID and others. At present these infections increase morbidity and unusually they are life-threatening. Newer therapies are available such as newer anti-viral agents, newer monoclonal antibodies and adoptive t-cell therapy. In organ transplant cases in the USA, COVID infection was around 48,000 cases and mortality was around 2400-4800 (5-10%). Vaccines decrease the incidence and severity of the infection. 

BK virus (BKV) is a common infection encountered after kidney transplantation. A high level of BK Viremia is associated with worse clinical outcomes. The approach to the management of BK post-kidney transplant includes surveillance testing. If significant viremia is detected, then there has to be a reduction in immunosuppression. 

Nonadherence is another issue in transplant patients. High calcineurin inhibitor intra-patient variability is a marker of non-adherence. Conventional immunosuppressants lack immunologic or Ag specificity and cause non-immunologic side effects. The need of the hour is safe and reliable induction of donor-specific tolerance. 

Recently there is an increase in long-term survival however clinicians need to focus on optimizing recipient characteristics, early referral, restructuring organ allocation, screening for acute rejection/viral infections, non-invasive biomarkers for the diagnosis of acute rejection and novel targeted therapy for clinical entities.