Monitoring for Viral Infections in Transplant Patients

Monitoring of transplant patients for viral infections allows individualized treatment regimens based on the risk for severe viral disease and quantification of viral loads in patient samples. Depending on the transplant type (solid-organ versus hematopoietic stem cell transplant), donor/recipient serostatus, degree of immunosuppression, and time from transplant, a variety of strategies can be used to manage the risk of post-transplant viral infections. They include empiric suppressive therapy, viral load monitoring, and diagnostic testing algorithms. Since the majority of transplant-associated viral infections are due to reactivation of latent infection, monitoring for viremia can allow early detection and initiation of antiviral therapy or a decrease of immunosuppressive medication in an attempt to limit progression to severe disease. Viral load tests using quantitative-PCR methods are a standard method for monitoring viremia, allowing early detection and tracking of viral infections in this immunocompromised patient population, yet there is limited standardization of testing methods between laboratories.