Clinical and laboratorial profiles of dengue virus infection in kidney transplant recipients: Report of a single center

Dengue in patients with kidney transplant: a systematic review

Introduction

The incidence of dengue and its complications increases globally, mainly in areas where it is endemic; however, little literature evaluates outcomes in kidney transplant recipients (KTR). The present analysis aimed to determine the incidence, signs and symptoms, and allograft dysfunction in dengue-infected KTR.

Methods

Systematic review of the literature following PRISMA 2020 indications with studies included until November 24, 2023.

Results

Of 309 articles found, seven full-text studies were identified for analysis. 4337 KTRs with 214 dengue cases were evaluated. The incidence of dengue was 4.93%, varying between geographic regions. The average age was 41.50 years, and 61.21% were men. A mortality of 7.01% was reported. The symptoms were fever 83.18%, arthralgia 19.46%, myalgia 43.24% and headache 34.18%. The proportions of febrile dengue, with warning signs and severe dengue, were 63.55%, 23.83% and 11.68%, respectively. Transplant dysfunction and loss occurred in 63.08% and 4.67%, respectively.

Conclusions

Although the global distribution of dengue in KTR is unknown, there is a variable incidence between geographical areas and study times in which the KTR are evaluated. There is a high incidence of febrile symptomatology and transplant dysfunction consistent with global cohorts for non-KTR and KTR patients, respectively. Dysfunction is a prevalent event in KTRs with dengue infection, so correct screening should be done for donors and transplant candidates.

A Scoping Review of Arthropod-Borne Flavivirus Infections in Solid Organ Transplant Recipients

Arthropod-borne flaviviruses (ABFs), transmitted by mosquitoes or ticks, are increasing due to climate change and globalization. This scoping review examines the epidemiology, clinical characteristics, diagnostics, treatment, and outcomes of ABF infection in solid organ transplant recipients (SOTRs). A database search up to January 25, 2024, focused on ABFs such as West Nile virus (WNV), dengue virus (DENV), Japanese encephalitis virus (JEV), Powassan virus (POWV), yellow fever virus (YFV), and Zika virus (ZIKV), limited to SOTRs. We identified 173 WNV cases from 84 studies, with 28 donor-derived infections (DDIs). Common clinical features included fever (78.5%), altered mental status (65.1%), and weakness or paralysis (45.6%). Treatment involved reducing immunosuppression (IS) in 93 cases, with intravenous immunoglobulin (IVIG), interferon alfa-2b, and ribavirin used in 75 cases. Seven cases involved graft loss or rejection post-infection. WNV infection had a 23.7% mortality rate, with severe neurological complications in 43.9% For DENV infection, 386 cases from 47 studies were identified, including 14 DDI cases. Symptoms included fever (85%), myalgias (56.4%), and headache or retro-orbital pain (34.6%). Severe dengue occurred in 50 cases (13.0%). IVIG was administered in six cases. Reduction in IS was reported in 116 patients. DENV mortality rate was 4.9%. Additionally, 26 cases of less common ABFs such as JEV, POWV, YFV, and ZIKV were described. In summary, ABF infections among SOTRs are associated with higher morbidity and mortality compared to the general population, emphasizing the need for improved preventive strategies, timely diagnosis, and optimized management protocols.

Arbovirus in Solid Organ Transplants: A Narrative Review of the Literature

The incidence of arbovirus infections has increased in recent decades. Other than dengue, chikungunya, and West Nile viruses, the data on arbovirus in solid organ transplant (SOT) are limited to case reports, and infections in renal transplant recipients account for most of the reported cases. Dengue and West Nile infections seem to be more severe with higher mortality in SOT patients than in the general population. Acute kidney injury is more frequent in patients with dengue and chikungunya although persistent arthralgia with the latter is less frequent. There is no clear relationship between arboviral infection and acute cellular rejection. Pre-transplant screening of donors should be implemented during increased arboviral activity but, despite donor screening and negative donor nucleic acid amplification test (NAT), donor derived infection can occur. NAT may be transiently positive. IgM tests lack specificity, and neutralizing antibody assays are more specific but not readily available. Other tests, such as immunohistochemistry, antigen tests, PCR, metagenomic assays, and viral culture, can also be performed. There are a few vaccines available against some arboviruses, but live vaccines should be avoided. Treatment is largely supportive. More data on arboviral infection in SOT are needed to understand its epidemiology and clinical course.

Successful management of dengue in renal transplant recipients: A retrospective cohort from a single center

INTRODUCTION

The literature on dengue infection in renal transplant recipients has shown wide diversity in clinical presentation and outcome. The objective of this study was to report the clinical profile, short-term and long-term outcomes of dengue among renal transplant recipients.

METHODS

A total of 59 post-transplant dengue suspected cases were admitted from July 2019 to April 2020 of which 31 had confirmed dengue infection. The clinical and laboratory profile of the confirmed dengue cases (n = 31) were compared with non-dengue cases (n = 28).

RESULTS

Among the clinical and laboratory features retro-orbital pain, conjunctival redness, thrombocytopenia on admission, and absence of arthralgia were significantly associated with dengue compared to non-dengue cases. No mortality was observed in the dengue cases. Allograft dysfunction, acute rejection and graft losses were identified in 64.5% (n = 20), 6.4% (n = 2) and 6.4% (n = 2) dengue cases respectively. No rejection or graft losses were observed in 1-year follow-up.

CONCLUSIONS

We report a differential clinical profile for dengue in transplant settings which will aid in the diagnosis. We also report successful management of dengue infection in renal transplant recipients with the majority having allograft dysfunction. A long-term follow-up of the cohort was uneventful.