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The following is a summary of “Transplant centers’ prophylaxis and monitoring strategies: a key determinant of current herpes and polyomavirus incidences – results from the DZIF kidney transplant cohort,” published in the April 2025 issue of BMC Nephrology by Sommerer et al. 

Researchers conducted a retrospective study to evaluate transplant centers’ adherence to established herpes- and polyomavirus prophylaxis and monitoring guidelines and the impact on infection rates and patient outcomes.  

They included 1,035 recipients with kidney transplants from 5 centers (01/2014–02/2021) in a study focused on herpes- and polyomavirus viremia within the first year and also evaluated adherence to prophylaxis strategies across the centers.  

The results showed that 26.6% of the 1,035 recipients developed herpes- or polyomavirus viremia, primarily Cytomegalovirus (CMV, 14.3%) and BK-virus (BKV, 13.2%), BKV monitoring was less frequent than recommended by guidelines. Deviations from guidelines were most common in the CMV D−/R− group (34.6% received prophylaxis) and D−/R+ group (37.3% lacked prophylaxis), with CMV incidence doubling in the D−/R+ group (28.9% vs 12.5%, P< 0.01). In the D+/R− group, 6-month prophylaxis reduced CMV incidence compared to 3 months (22.5% vs 38.4%, P< 0.01). Breakthrough viremia was most frequent in D+/R− recipients on 6-month prophylaxis. Viremia was linked to a higher incidence of acute rejection (31.9% vs 17.6%, P< 0.01), with most CMV viremias occurring after rejection and the CMV viremia increased the risk of bacterial infection (Hazard ratio (HR) = 1.77, [1.03; 3.02]), while other herpesviruses raised the risk of fungal infection (HR = 4.34, [1.03; 18.30]) and non-administration of CMV prophylaxis (HR = 0.22, [0.11; 0.47]). Graft survival and mortality were unaffected during the first year.  

Investigators concluded that clinical variability in guideline adherence contributed to high herpes- and polyomavirus infection rates, with suboptimal outcomes, suggesting that future guidelines should incorporate differentiated risk stratification and protocols for early detection of secondary infections. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04084-5