Herpesviruses and polyomaviruses in renal transplantation.

Viral infections remain a significant cause of morbidity and mortality among transplant patients despite recent advances in early detection and treatment. Herpesviruses and polyomaviruses are the most relevant viruses post-transplant as they establish latency in immunocompetent individuals and frequently reactivate in the immunosuppressed transplant recipient. Although we have made significant strides in the early diagnosis and treatment of viral infections in renal transplant recipients over the past five years, many questions remain. Optimization of screening and prophylactic/preemptive protocols, as well as standardization of viral diagnostic testing are still needed. Understanding how viruses modify the host's immune responses, and conversely how variations between hosts' ability to mount an immune response against viruses are important areas of research that might allow for more individualization of immunosuppressive regimens. Other exciting areas of ongoing study include the associations between various HLA loci/mismatches and viral replication/infection, the mechanisms by which certain viruses (i.e., Epstein-Barr virus, human herpes virus 8) are oncogenic, and the development of new therapeutic strategies such as adoptive transfer of antigen-specific T cells to restore immunity and control viral infections.

Lambda light chain deposition disease in a renal allograft.

Light chain deposition disease (LCDD) of the kidney is characterized by deposition of monoclonal light chains predominantly in glomeruli and in tubular basement membranes. The disease is frequently associated with a lymphoproliferative disorder, and the majority of cases are caused by deposition of kappa light chains. Although the occurrence of de novo multiple myeloma after renal transplantation is uncommon, there are several reports of LCDD involving renal allografts, either de novo or in patients with a diagnosis of LCDD prior to transplantation. To the best of our knowledge, all previously described cases in allografts have been in patients with kappa chain deposition. The relative importance of intrinsic properties of the kidney in predisposing to either kappa or lambda light chain deposition is not known. We present a case of LCDD caused by deposition of lambda light chains in a patient who received a cadaveric renal transplant.