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The purpose of this review is to describe the characteristics of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) in transplant recipients. The majority of reported cases were transmitted by mosquito bite, but blood and graft transmission may occur. These arbovirus infections are clinically similar, resembling influenza-like illness or frequent transplant syndromes. Therefore, laboratory confirmation is necessary. In the acute phase, nucleic acid tests are preferred. DENV and ZIKV serology may cross-react. The assessment of epidemiological risk is mandatory in donors and patients returning from endemic areas. Current data show that DENV may be severe, with a protracted course, prolonged viremia, and bleeding complications. Transient graft dysfunction and altered liver enzymes are expected. No specific treatment is currently available, and the management of arboviruses is mainly supportive, with attention to warning signs of decompensation. Reduction of immunosuppression is not recommended as it may trigger rejection or graft-versus-host disease. Available DENV vaccines are not recommended in transplant recipients. CHIKV and ZIKV vaccines are in early stages of development. Arbovirus persistence in organ and tissues is generally unknown. Consequently, screening and deferral recommendations are still controversial. Donor screening can be considered in symptomatic donors or in those returning from endemic areas. Donor deferral for 30 days has been recommended in suspected or confirmed DENV or CHIKV, while in case of suspected ZIKV, longer quarantine period has been proposed (up to 6 months). Prospective studies are necessary to determine the impact of DENV, CHIKV, and ZIKV in this special population.

DOI: 10.1007/978-3-030-01751-4_40-1