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  • Rosa Emilia Moraes

Monkeypox risk warning for liver transplant patients

A case of infection in an individual outside the epidemiological profile reinforces the need for

attention on the part of the transplant community for proper diagnosis and orientation of

patients about the virus. Incipient literature does not yet cover the impacts of the disease on

solid organ transplant patients.


Article: Genzini, T.; Santos, R. G. dos; Rodriguez, T. N.; Stucchi, R. S. B.; Fonseca, L. E. P. da; Marzinotto, M. A. N.; Figueiredo, S. R. de; Rodrigues, M. G.; Almeida, T. N. de; Perosa, M. Monkeypox em paciente transplantado hepático. Brazilian Journal of Transplantation, v. 26 (01):e2023.


Monkeypox risk warning for liver transplant patients

Monkeypox (MPOX) is a viral, zoonotic disease that can be transmitted by contact between humans and wild animals, or by intimate contact (skin-to-skin) with an infected individual. An increase in cases outside endemic regions on the African continent led the World Health Organization (WHO) to declare a state of international health emergency for Monkeypox in July 2022.

Although current knowledge sees it as a viremia with low lethality - around 1 to 5%, according to Slenovská and Van Ranst (2018) - some groups are considered to be at risk of complications. These include patients undergoing transplants, especially during periods of peak immunosuppression, when viral infections are common. However, in this context, recorded scientific knowledge is still scarce.

To observe the evolution of the virus in this specific population, researchers from the Oswaldo Cruz German Hospital and the Unicamp School of Medical Sciences published an article in the Brazilian Journal of Transplantation (v.26), describing the case of an elderly patient with various comorbidities, who had recently undergone a successful liver transplant, was receiving immunosuppressive treatment and presented lesions compatible with MPOX in the 3rd postoperative month.

What stands out in the report is the lack of epidemiological history, since the patient had not been to regions at risk of endemic disease, and denied close contact with infected people, eliminating the hypotheses considered by the current literature to be the main routes of transmission, and thus reinforcing the question about the possibility of MPOX being transmitted by respiratory means. The diagnosis was confirmed using the RT-PCR test.

Despite causing a significant number of lesions, the disease progressed without severity and the patient recovered fully. He did not receive specific antiviral treatment as there is no such treatment available in Brazil. Infected individuals should remain in isolation until the lesions have healed completely, in around four weeks.

The article also raises other questions regarding the impact of MPOX infection on patients undergoing solid organ transplants, aspects which have not yet been clarified by the scant literature produced to date. The transplant community must be alert to diagnostic suspicion in the face of typical lesions, and to correctly guide transplant patients about risk exposure.


Read more (References):

Sklenovská N; Van Ranst M. Emergence of monkeypox as the most important Orthopoxvirus

infection in humans. Frontiers in Public Health, 6:241, 2018.



Rosa Emilia Moraes, Scientific journalist at Linceu Editorial, São José dos Campos, SP, Brazil (



Brazilian Journal of Transplantation

Hospital Alemão Oswaldo Cruz

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