Adenovirus Disease after Kidney Transplantation: Course of Infection and Outcome in Relation to Blood Viral Load and Immune Recovery

Abstract

kidney transplant recipients were diagnosed with adenovirus disease. The median time to infection was 5 (range, 2-300) weeks after transplantation. Of the 17 patients, 13 (76.5%) presented early, within 3 months posttransplant, and four (23.5%) presented late, more than 3 months after transplant. Besides urinary tract, involvement of other organs was common (63.6%) among patients with adenovirus viremia. Despite reduction of immunosuppression, six patients subsequently had a rise in the level of blood viral load, mostly within a week after diagnosis. However, only three (27.3%) patients with early infection developed disease progression. Compared to the late infection group, patients with early infection had significantly lower absolute lymphocyte counts at week 1 (p = 0.01) and 3 (p = 0.002) after diagnosis. Four patients received intravenous cidofovir. At 6-month follow-up, 10 (90.9%) patients had reversible graft dysfunction. Only one (5.7%) died from bacterial sepsis. Adenovirus disease is a significant complication following kidney transplantation. Early case recognition with reduction of immunosuppression is critical. Serial blood adenovirus viral loads and assessment of lymphocyte recovery are also useful in monitoring the course of infection.

Adenovirus Infections in Immunocompetent and Immunocompromised Patients

“…Infections can be acquired de novo or via reactivation of latent virus from the recipient or the transplanted organ (157). The occurrence of adenoviremia has been reported to be less than 10% of adult patients after kidney, heart, or liver transplantation; although the symptoms of HAdV infection are usually mild, and invasive infection does not correlate with organ rejection (157), severe and even fatal courses have also been described (158,159). Studies in patients undergoing lung transplantation showed that pulmonary infection with HAdV can correlate with significantly elevated rates of rejection, bronchiolitis obliterans, and mortality (160)(161)(162).…”

“…Clinical manifestations reported for patients receiving lung, liver, kidney, or small bowel transplants include pneumonia, hepatitis, nephritis, hemorrhagic cystitis, enteritis, and disseminated disease (97). The manifestations tend to be more severe in pediatric transplant populations, with reported mortality rates occasionally exceeding 50% (179), and surveillance of HAdV loads in peripheral blood may be instrumental for identifying patients requiring antiviral treatment to prevent fatal disease (159,164,180). In adult patients undergoing SOT, the incidence of viremia is lower, and the presence of HAdV is often transient and self-limited, with asymptomatic clinical courses.…”

Adenovirus infections in immuncompromised patients

“…A B-speciesbe tartozó adenovírusok gyakran kimutathatók vizeletből, némely szerotípus előfordulása általánosnak tekinthető [36]. Disszeminált fertőzés esetén a vírusok a belekben és a légutakban, herékben, vérben és sok belső szervben is megtalálha-tók [37]. Vesetranszplantáltak körében az adenovírus-fertőzések mortalitási rátája nem magas, de leírtak már spontán gyógyuló haemorrhagiás cystitist éppúgy, mint halálos kimenetelű fertőzést [38,39].…”

“…A 300/μl alatti lymphocytaszám a viraemiás betegek csökkent túlélési valószínűségét jelzi [9]. A lymphocytaszám helyreállásának nyomon követése hasznos lehet adenovírus-fertőzések során [37]. Az adenovírus-specifi kus CD4+ sejtek IFN-γ és IL-2 termelésének monitorozása alkalmasnak tűnik a kockázatnak kitett betegek felderítésében [58].…”

A Case of Late Kidney Allograft Failure

“…PCR on the urine tests is positive for viral DNA. Monitoring of serum viral loads may be useful in monitoring disease (29). In medical centers with good electron microscopy facilities, an alternate way of making the diagnosis is to perform scanning electron microscopy on a urine sediment or biopsy tissue and show viral capsids measuring about 70 nm in diameter.…”