Adenovirus Infection in Solid Organ Transplant Recipients
Vikas Mehta, Kumaran Mudaliar, Pauline C Chou, Maria M Picken. Loyola University Medical Center, Chicago, IL; Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
Background: Adenoviral (AdV) infection in an immunocompromised host carries a mortality rate approaching 80%. It is seen most frequently in bone marrow transplant recipients, but in solid organ transplant (SOT) recipients it usually involves the graft only. Most of the adenovirus disease develops in the first 6 months after transplantation, particularly in pediatric patients. Among abdominal organ recipients, small bowel grafts are most frequently affected, presumably due to the presence of a virus reservoir in the mucosa-associated lymphoid tissue. However, other grafts may also be involved. AdV graft infection leads to graft loss in most instances. Therefore, an awareness of the pathology associated with such infections is important in order to allow early detection and specific treatment.
Design: We reviewed 6 SOT recipients with AdV graft involvement from 2 institutions We sought to compare the diagnostic morphology and the clinical and laboratory findings.
Results: There were 4 females and 2 males with small bowel (x3), heart (x1) and renal transplants (x2, both adults); 4 children (age 2-5) and 2 adults (53 and 61) years. Kidney biopsies were done for renal failure with hematuria; small bowel for diarrhea; clinically stable heart allograft biopsy was done following a prior diagnosis of AdV native kidney nephritis. All patients had AdV (+) serology; stool was (+) in 3 small bowel transplant recipients. Immuno stain (IHC) for AdV was positive in all grafts and in 1 native kidney. In the kidney (graft x2 and native x1), necrosis was tubulocentric with a vaguely granulomatous mixed inflammatory infiltrate associated with rare cells with a cytopathic effect. There was also a lymphocytic infiltrate, simulating T-cell rejection, with admixture of eosinophils. In the small bowel grafts, there was a focal mixed inflammatory infiltrate with associated necrosis. In the heart, allograft AdV was detected by IHC in the absence of necrosis. All patients were subsequently treated and cleared AdV infection, as evidenced by follow-up biopsies, with no loss of the grafts.
Conclusions: AdV infection can involve allografts and native kidney in SOT recipients. Infection is associated with variable necrosis and acute inflammation, in addition to a rejection-like infiltrate. Hematuria in non-renal SOT recipients may be associated with AdV nephritis and clinically-silent graft involvement. Prompt diagnosis (aided by IHC and serology), with specific treatment, can prevent graft loss.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 252, Wednesday Morning