Virus-specific T cells in pediatric renal transplantation

Pediatr Nephrol. 2021 Apr;36(4):789-796. doi: 10.1007/s00467-020-04522-6. Epub 2020 Mar 27.

Abstract

After pediatric kidney transplantation, immunosuppressive therapy causes an increased risk of severe viral complications, especially from cytomegalovirus (CMV), BK polyomavirus (BKPyV) or Epstein-Barr virus (EBV), and less frequent from adenovirus (ADV). However, suitable predictive markers for the individual outcome of viral infections are missing and the therapeutic management remains a challenge to the success of pediatric kidney transplantation. Virus-specific T cells are known for controlling viral replication and there is growing evidence that virus-specific T cells may serve as a prognostic marker to identify patients at risk for viral complications. This review provides an overview of the usability of virus-specific T cells for improving diagnostic and therapeutic management of viral infections with reference to the necessity of antiviral prophylaxis, timing of pre-emptive therapy, and dosing of immunosuppressive medication after pediatric kidney transplantation. Several studies demonstrated that high levels of virus-specific T cells are associated with decrease of virus load and favorable outcome, whereas lack of virus-specific T cells coincided with virus-induced complications. Accordingly, the additional monitoring of virus-specific T cells aims to personalize the management of antiviral therapy, identify overimmunosuppression, and avoid unnecessary therapeutic interventions. Prospective randomized trials in pediatric kidney recipients comparing standard antiviral and immunosuppressive regimens with T cell-guided therapeutic interventions are needed, before monitoring of virus-specific T cells is implemented in the routine care of pediatric kidney graft recipients.

Keywords: Adenovirus; BK polyomavirus; Cytomegalovirus; Epstein-Barr virus; Immunosuppression; Kidney transplantation; Pediatric transplantation; Prognostic marker; Viral infections; Virus-specific T cells.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • BK Virus*
  • Child
  • Epstein-Barr Virus Infections*
  • Herpesvirus 4, Human
  • Humans
  • Kidney Transplantation* / adverse effects
  • Polyomavirus Infections*
  • Prospective Studies
  • T-Lymphocytes

Substances

  • Antiviral Agents