Diagnosis and Monitoring of Viral Infections in the Transplant Population

Viral infections are a major cause of morbidity and mortality in patients undergoing solid organ or hematopoietic stem cell transplantation. Due to their immunocompromised status, transplant recipients are at a higher risk for community-acquired and reactivated viral infections. Serologic screening prior to transplantation can assist with risk stratification of patients and guide decisions regarding the use of pre-emptive antiviral therapy. Following transplantation, molecular testing has become the most common method to detect viral infections, with histopathology of infected tissue often being required to confirm a diagnosis. Quantitative nucleic acid amplification tests have been the standard to detect and monitor viral infections in transplant patients; however, important challenges remain, including lack of standardization across many testing laboratories, limited availability of FDA-approved viral load assays, and the absence of universal viral load thresholds that can be used to diagnose disease and guide management decisions.