Transplant in the age of global warming: What is known about the impact of emerging tropical arbovirus infections

Abstract

Climate change and human migration continue to impact the infectious risks of transplantation, as emerging infections are newly recognised in transplant candidates and recipients. Limited data about the risks of these novel pathogens in transplant make decisions about the optimal timing and safety of transplant challenging, particularly in areas experiencing the initial presentation of new arboviruses. This presentation will focus on information available about the clinical manifestations of Dengue, Chikungunya, and Zika virus infections in transplant recipients. The limitations and challenges of laboratory diagnosis in the transplant candidate and recipient will be discussed, and the existing data on clinical syndromes reviewed. Recommendations for patient management and infection avoidance will also be covered, along with current clinical guidelines regarding transplant donor and candidate eligibility for transplant in areas experiencing active arbovirus infection transmission. Some infectious risks are inherent to the transplant process, and widely acceptable due to the significant benefits of transplant. Understanding the implications of emerging infections on the immunocompromised transplant population remains a work in progress, and research in this area is essential to successfully mitigate risk. The morbidity and mortality of West Nile virus infection in transplant recipients demonstrates the potentially severe manifestations of arbovirus infection in this population, and the need to closely monitor outcomes whenever novel infectious agents initially present in unique immunosuppressed patient groups.