Viral infection in the renal transplant patient.

With the advances that have occurred over the last two decades in the prevention and treatment of bacterial and fungal infection, viral infection has been recognised as an important problem in renal transplant patients. Four groups of viruses--the herpesviruses, hepatitis viruses, papovaviruses, and adenoviruses - appear to have a particular impact on this patient population, especially the first two of these. The effects of these viruses can be categorised as follows: the production of infectious diseases by the virus itself; the production of an immunosuppressed state that predisposes to opportunistic superinfection; the production of a unique form of allograft injury; and the production of malignancy. It is the recognition of these last three categories of viral effect that has led to a reawakening of interest in these agents in recent years. In particular, the interaction among rejection, innovative forms of immunosuppression, and reactivated viral infection in the pathogenesis of malignant disease, which occurs at a markedly increased rate in this patient population, offers a major frontier of human biology whose importance extends far beyond the renal transplant population.