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Sarah B. Klieger, Richard Hodinka, Adriana Kajon, Hans Petersen, Ana Maria Cardenas, Jerica Gee, Laura Smallcomb, Evangelos Spyridakis, Brian T. Fisher, Epidemiology of Adenovirus Infection and Disease Among Pediatric Solid Organ Transplant Recipients, Open Forum Infectious Diseases, Volume 2, Issue suppl_1, December 2015, 480, https://doi.org/10.1093/ofid/ofv133.355
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Background. Human adenovirus (HAdV) is associated with poor outcomes in immunosuppressed patients but data in pediatric solid organ transplant (SOT) populations are limited. We aimed to describe the epidemiology and outcomes of HAdV in pediatric SOT recipients.
| Characteristic . | Total (n = 350) . | Lung (n = 28, 8%) . | Heart/Heart-Lung (n = 78, 22%) . | Liver (n = 119, 34%) . | Kidney (n = 131, 37%) . |
|---|---|---|---|---|---|
| Age, years (Median, IQR) | 9 (2 to 14) | 12 (5 to 15) | 4 (0 to 12) | 2 (1 to 7) | 10 (6 to 13) |
| Sex, male* | 200 (57.1) | 11 (39.3) | 45 (57.7) | 72 (60.5) | 78 (59.5) |
| HAdV Positive* | 23 (6.6) | 3 (10.7) | 6 (7.7) | 13 (10.9) | 3 (2.3) |
| HAdV Disease* | 9 (2.6) | 2 (7.1) | 3 (3.8) | 4 (3.4) | 1 (0.8) |
| Characteristic . | Total (n = 350) . | Lung (n = 28, 8%) . | Heart/Heart-Lung (n = 78, 22%) . | Liver (n = 119, 34%) . | Kidney (n = 131, 37%) . |
|---|---|---|---|---|---|
| Age, years (Median, IQR) | 9 (2 to 14) | 12 (5 to 15) | 4 (0 to 12) | 2 (1 to 7) | 10 (6 to 13) |
| Sex, male* | 200 (57.1) | 11 (39.3) | 45 (57.7) | 72 (60.5) | 78 (59.5) |
| HAdV Positive* | 23 (6.6) | 3 (10.7) | 6 (7.7) | 13 (10.9) | 3 (2.3) |
| HAdV Disease* | 9 (2.6) | 2 (7.1) | 3 (3.8) | 4 (3.4) | 1 (0.8) |
*n (%)
This work was supported in part by National Institutes of Health/National Institute of Allergy and Infectious Diseases Contract no. HHSN2722011000040C.
Methods. We retrospectively identified all SOT at Children's Hospital of Philadelphia between 2006 and 2013. Laboratory data were reviewed to identify specimens positive for HAdV by PCR within 180 days from transplant. HAdV disease was defined as HAdV detection plus evidence of organ dysfunction. Medication records for HAdV positive patients were reviewed for receipt of at least one dose of cidofovir. HAdV-related death was defined as declaration of HAdV disease without resolution of symptoms prior to death or evidence of HAdV pathology at autopsy.
Results. There were 350 SOT patients with a median age of 9 years (IQR: 2 to 14) (table). HAdV was detected in at least one specimen for 23 (6.6%) patients and was most common in lung and liver transplant recipients. Nine patients had one or more HAdV disease events: 6 pneumonitis, 3 hepatitis, and 1 colitis. Only 3 HAdV positive patients received cidofovir, including 1 patient with asymptomatic HAdV and 1 patient each with HAdV pneumonitis and hepatitis. There were 12 (3.4%) deaths in the cohort none of which were attributed to HAdV disease.
Conclusion. In this pediatric SOT cohort, the detection of HAdV by PCR was infrequent at 6.6% with only 2.6% of patients meeting criteria for HAdV disease. Cidofovir was infrequently utilized and although the comparative effectiveness of cidofovir could not be assessed, cidofovir was not necessary to resolve HAdV disease. Future, prospective multi-center studies are needed to confirm the epidemiology of HAdV in SOT and to establish the comparative effectiveness of cidofovir in this setting.
Disclosures. B. T. Fisher, Pfizer: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant
Author notes
Session: 65. Pediatric Viral Infections
Thursday, October 8, 2015: 12:30 PM
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