Table 1: Common viral pathogens in renal transplant recipients, time of their presentation, prevalence, prevention and available cures.

Common viral pathogens in renal transplant recipientsTime of their presentationPrevalence in renal transplant populationPreventionTherapy and available cures

CytomegalovirusMonths 3–12
Months 1–3 (in absence of prophylaxis)
Beyond 1 year (in setting of extended prophylaxis)
8–32%Serologic screening for antibody donor and recipient, universal prophylaxis include acyclovir, ganciclovir, valacyclovir, valganciclovir, and immune globulin preparationsCombination of immunomodulation, antiviral therapy (intravenous ganciclovir, valganciclovir, foscarnet, cidofovir, and leflunomide) and reduction of immunosuppression
Herpes simplexFirst Month, Months 1–3approximately 53%Serologic screening for antibody donor and recipientAcyclovir
Varicella zosterMonths 1–64–12%Serologic screening for antibody donor and recipient, live attenuated varicella vaccineGanciclovir, valacyclovir, acyclovir
Epstein-Barr virusMonths 1–121–3%EBV load testing is commonly usedReduction of immunosuppression, infusing donor lymphocytes, infusing EBV-specific cytotoxic T and infusing anti-CD20 monoclonal antibody
Human herpesvirus-6First Month, Months 1–3No dataSerologic screening for antibody donor and recipientReduction of immunosuppression, ganciclovir, cidofovir, foscarnet
Human herpesvirus-7First Month and Months 1–3No dataSerologic screening for antibody donor and recipientReduction of immunosuppression, ganciclovir, cidofovir, foscarnet
Human herpesvirus-8Months 6–12 and beyond 1 year0.2–5%Optional screening measuresReduction of immunosuppression, rapamycin
Polyomavirus BK/JCMonths 3–12 and beyond 1 year1%–10%Quantitative nucleic acid-based viral load assay of urine or blood, urine cytology, polymerase chain reactionReduction of immunosuppression, cidofovir, leflunomide, quinolones, and intravenous immunoglobulin
Hepatitis B and C (acquisition of new infection)Months 1–12 and beyond 1 yearNo dataSerologic screening for antibody donor and recipientReduction of immunosuppression lamivudine, adefovir, and entecavir
Hepatitis B and C (reactivation)First Month, Months 1–32–10%Serologic screening for antibody donor and recipientInterferon (associated with an increased risk of allograft rejection)
Human immunodeficiency virusNo dataNo dataSerologic screening for antibody donor and recipientThe optimal management of immunosuppression in HIV infected individuals remains unknow
Adenovirus, respiratory, syncytial virus, influenza, parainfluenza, human metapneumovirus, rhinovirus, and coronavirusMonths 1–12 and beyond 1 yearNo dataInfluenza vaccineOseltamivir, zanamavir, ribavirin, cidofovir
West Nile virus (acquisition from transplant)First MonthNo dataOptional Screening MeasuresReduction of immunosuppression
West Nile virus (acquired after transplant)Months 1–12 and beyond 1 yearNo dataOptional Screening MeasuresReduction of immunosuppression