RESUMO
The development of multiple highly effective and safe direct-acting antivirals to treat hepatitis C virus (HCV) has resulted in greater ease and confidence in managing HCV infection in transplant recipients that in turn has impacted the solid organ transplant community as well. In the United States, the opioid epidemic has increased the number of overdose deaths with a concomitant increase in younger HCV viremic donors after brain death being identified. At the same time, a decrease in HCV viremic transplant candidates has led to a growing interest in exploring the use of HCV viremic liver and kidney donor allografts in HCV-negative recipients. To date, experience with the use of HCV viremic liver and kidney allografts in HCV-negative recipients is limited to a few small prospective research trials, case series, and case reports. There are also limited data on recipient and donor selection for HCV viremic liver and kidney allografts. In response to this rapidly changing landscape in the United States, experts in the field of viral hepatitis and liver and kidney transplantation convened a meeting to review current data on liver and kidney recipient selection and developed consensus opinions related specifically to recipient and donor selection of HCV viremic liver and kidney allografts.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/transmissão , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Aloenxertos/patologia , Aloenxertos/virologia , Antibioticoprofilaxia/normas , Biópsia , Consenso , Conferências de Consenso como Assunto , Seleção do Doador/normas , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Humanos , Rim/virologia , Transplante de Rim/normas , Fígado/patologia , Fígado/virologia , Transplante de Fígado/normas , Complicações Pós-Operatórias/virologia , Transplantados , Estados Unidos , Viremia/transmissão , Viremia/virologiaRESUMO
BACKGROUND: Saliva samples could be used for follow-up of herpesviruses infection in pediatric transplant recipients. OBJECTIVE: With the aim of determining the frequency of herpesviral infections in saliva samples after transplantation, and the association with viremia and complications, a pilot longitudinal follow-up of pediatric Cuban transplanted recipients (kidney and liver) was performed. METHODS: Quantitative real-time polymerase chain reaction of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus, human herpesevirus-6 (HHV6), varicella zoster virus, and human herpesvirus-8 were serially assayed in saliva and serum samples from 27 transplanted patients, during 32 weeks after the graft. Samples taken immediately after the graft were used as control samples. RESULTS: Herpesviruses were detected in 88.9% of saliva and in 37.0% of serum samples. HHV6 and CMV were the viruses more frequently detected (70.4%) in saliva and they were significantly more frequent during the follow-up in comparison with control samples (P < .05). Most patients (22/27) had more than one virus shedding concurrently. Patients with CMV in saliva were associated with CMV viremia (P = .009), particularly at the cutoff of 252.5 copies/mL, with a less accurate level of area under the curve. No association between CMV viral load in saliva and viral disease or response to the antiviral treatment was observed. CONCLUSIONS: The association found between CMV shedding in saliva and CMV viremia in this study opens the possibility of future studies of using viral load in saliva as a predictor of viremia. The implementation of herpesviral load in saliva samples for early clinical intervention in pediatric recipients needs a study with a large number of samples for further conclusions.
Assuntos
Infecções por Herpesviridae/epidemiologia , Herpesviridae/isolamento & purificação , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Saliva/virologia , Adolescente , Aloenxertos/patologia , Aloenxertos/virologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Cuba/epidemiologia , Infecções por Herpesviridae/sangue , Infecções por Herpesviridae/patologia , Infecções por Herpesviridae/virologia , Humanos , Hospedeiro Imunocomprometido , Lactente , Rim/patologia , Rim/virologia , Fígado/patologia , Fígado/virologia , Estudos Longitudinais , Projetos Piloto , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/virologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Transplantados/estatística & dados numéricos , Carga Viral , Eliminação de Partículas ViraisRESUMO
BACKGROUND: BK virus (BKV) may reactivate in kidney allograft recipients ultimately leading to BKV nephropathy and graft loss. Decoy cells (DCs) are one of the early marks of BKV reactivation, and these can be detected in the urine sediment. METHODS: A cohort of 102 kidney transplant patients was followed during months 3 and 6 after the transplant procedure. Urine samples were obtained to detect the presence of DC in the fresh and unstained urine sediment under bright field microscopy (BFM), in concomitance to the determination of the amount of BK viruria by qPCR. RESULTS: Decoy cells were found in 14.7% of patients (15/102). There was a strong agreement (P < 0.001) between qualitative DC detection by two experienced analysts and by qPCR. The positive predictive value, negative predictive value, specificity, and accuracy of BFM were 80%, 75%, 97%, and 75%, respectively. Test sensitivity was 16%. The comparative method was the qPCR. CONCLUSIONS: Despite its limited sensitivity, BFM of unstained urine sediment is an easily available, fast and cheap method to identify DCs in the population of kidney allograft recipients. The diagnostic performance of BFM on the hands of less experienced analysts deserves further investigation.