What do we know about adenovirus in renal transplantation?

Abstract

Adenoviruses are common pathogens that have the potential to cause opportunistic infections with significant morbidity and mortality in immunocompromised hosts. The significance of adenoviral infection and disease is incompletely known in the setting of kidney transplantation. Reported adenovirus infections in renal transplant recipients have typically manifested as hemorrhagic cystitis and tubulointerstitial nephritis, less severe diseases than often seen in other solid organ transplant recipients (i.e. pneumonia, hepatitis and enteritis). The prevalent adenovirus subgroups associated with cystitis and nephritis are B1 and B2 with the serotypes 7, 11, 34, 35. However, disseminated or severe adenovirus infections, including fatal cases, have been described in renal transplant recipients. There is uncertainty regarding monitoring of and treatment of this virus. Although not supported by randomized clinical trials, cidofovir is used for the treatment of adenovirus disease not responding to reduction of immunosuppression.

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).…”

Respiratory Viruses: Influenza, RSV, and Adenovirus in Kidney Transplantation

“…Adenovirus is unique in that, although PCR is the preferred diagnostic test, negative testing from the upper or lower airway may not exclude infections. 13,14 Some assays detect some but not all of the serotypes. 14 Furthermore, adenovirus replication can occur in the absence of clinical symptoms and positive testing must be contextualized with the patients presenting signs and symptoms.…”

“…Such pathology is helpful in distinguishing local infection (ie, adenovirus interstitial nephritis) from organ rejection or other pathology. 14…”

Cystite hémorragique à adénovirus chez le transplanté rénal : à propos d’un premier cas en Afrique noire survenu dans un tout débutant programme de greffe rénale et revue de la littérature

“…Chez l'immunodé primé , les manifestations cliniques peuvent être graves. Bien que les complications virales soient une cause majeure de morbidité et de mortalité chez le transplanté ré nal, l'infection à adé novirus est peu fré quente [1][2][3][4][5][6].…”