Strategies for the prevention of infectious complications after renal transplantation

PURPOSE OF REVIEW: Prevention of infectious complications after renal transplantation is of enormous clinical importance. It is a rapidly evolving target, given the changes in peritransplant microbial epidemiology and the availability of newer diagnostics and therapeutics. The review addresses recent developments in infectious prophylaxis. RECENT FINDINGS: Valganciclovir has proved effective in cytomegalovirus prevention for prophylactic and preemptive therapy. Late cytomegalovirus disease postprophylaxis and the emergence of resistant strains are of increasing concern. Antiviral prophylaxis has lowered the rate of early post-transplant lymphoproliferative disease. Molecular diagnostic tests can facilitate the early detection of BK virus, leading to prevention of BK virus nephropathy and subsequent graft loss. In perioperative bacterial and candidal infection of the urinary tract, the rise in rate of infections with drug-resistant organisms is a major challenge. Newer tests are being studied for more reliable diagnosis of latent tuberculosis, as treatment before transplantation lowers the rate of post-transplant infection significantly. Finally, the new zoster and human papillomavirus vaccines may be useful for specific at-risk populations. SUMMARY: New diagnostic and therapeutic tools have increasingly facilitated early detection and intervention for several transplant-related infections, but further studies are needed to meet new challenges, such as rising antimicrobial resistance and emerging pathogens.