Adenovirus disease after kidney transplantation: Course of infection and outcome in relation to blood viral load and immune recovery

S. P. Watcharananan, Robin Avery, A. Ingsathit, K. Malathum, W. Chantratita, V. Mavichak, P. Chalermsanyakorn, S. Jirasiritham, V. Sumethkul

Research output: Contribution to journalArticle

Abstract

Information on the clinical spectrum and management of adenovirus infection after kidney transplantation is limited. From April 2007 to April 2010, 17 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. This study reports on the characteristics and outcome of adenovirus disease among kidney recipients and shows that prompt reduction of immunosuppression and close monitoring of blood viral load are useful, particularly in high-risk patients with infection early post-transplantation.

Original languageEnglish (US)
Pages (from-to)1308-1314
Number of pages7
JournalAmerican Journal of Transplantation
Volume11
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Viral Load
Adenoviridae
Kidney Transplantation
Infection
Immunosuppression
Transplantation
Transplants
Adenoviridae Infections
Viremia
Lymphocyte Count
Kidney Diseases
Urinary Tract
Disease Progression
Sepsis
Lymphocytes
Kidney

Keywords

  • Adenovirus
  • cidofovir
  • kidney transplantation
  • viral infection
  • viral load
  • viremia

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Adenovirus disease after kidney transplantation : Course of infection and outcome in relation to blood viral load and immune recovery. / Watcharananan, S. P.; Avery, Robin; Ingsathit, A.; Malathum, K.; Chantratita, W.; Mavichak, V.; Chalermsanyakorn, P.; Jirasiritham, S.; Sumethkul, V.

In: American Journal of Transplantation, Vol. 11, No. 6, 06.2011, p. 1308-1314.

Research output: Contribution to journalArticle

Watcharananan, SP, Avery, R, Ingsathit, A, Malathum, K, Chantratita, W, Mavichak, V, Chalermsanyakorn, P, Jirasiritham, S & Sumethkul, V 2011, 'Adenovirus disease after kidney transplantation: Course of infection and outcome in relation to blood viral load and immune recovery', American Journal of Transplantation, vol. 11, no. 6, pp. 1308-1314. https://doi.org/10.1111/j.1600-6143.2011.03479.x
Watcharananan, S. P. ; Avery, Robin ; Ingsathit, A. ; Malathum, K. ; Chantratita, W. ; Mavichak, V. ; Chalermsanyakorn, P. ; Jirasiritham, S. ; Sumethkul, V. / Adenovirus disease after kidney transplantation : Course of infection and outcome in relation to blood viral load and immune recovery. In: American Journal of Transplantation. 2011 ; Vol. 11, No. 6. pp. 1308-1314.
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abstract = "Information on the clinical spectrum and management of adenovirus infection after kidney transplantation is limited. From April 2007 to April 2010, 17 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. This study reports on the characteristics and outcome of adenovirus disease among kidney recipients and shows that prompt reduction of immunosuppression and close monitoring of blood viral load are useful, particularly in high-risk patients with infection early post-transplantation.",
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