Transplant infectious disease : an official journal of the Transplantation Society
-
Newer immunosuppressive strategies have resulted in a marked reduction in graft rejection after transplantation, with the price being an increase of infectious complications, such as BK-related nephropathy. The targeting of new immunosuppressive pathways, such as interleukin-2-mammalian target of rapamycin inhibition, may have unexpected consequences for the immune response. Cell-depleting agents have long-lasting effects on cellular recovery and function, with the activation of latent viral infections and late viral and fungal infections. ⋯ The possible role of specific drugs in the occurrence of infections is discussed, with emphasis on the antibodies and fusion proteins. The unequivocal attribution of a given infection to a specific drug is often impossible, as the risk of infection is dependent on the entirety of immunosuppression and the epidemiological pressure ('net immunosuppression'). It is important to remain vigilant for unexpected infections, not only in the context of clinical studies with selected patients, but also in the routine follow-up of our transplant patients.
-
Hepatitis B virus (HBV) has been transmitted by tissue transplantation. In order to reduce the risk of HBV transmission, testing for antibody to HBV core antigen (anti-HBc) is used in addition to testing for hepatitis B surface antigen (HBsAg) in many blood centers and tissue banks. ⋯ We consider that anti-HBc and NAT assays must both still be performed in addition to HBsAg assay for HBV screening in tissue donors. All these tests will be useful in order to define an algorithm for safe and efficient management of the tissue bank.