Adenovirus Nephritis in Renal and Other Solid Organ Transplant Recipients
Vikas Mehta, Kumaran Mudaliar, Pauline C Chou, Maria M Picken. Loyola University Medical Center, Maywood, 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, where it causes pneumonia and disseminated infection, but in solid organ transplant (SOT) recipients it can involve the graft. 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, including kidney, 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 3 SOT recipients with AdV kidney involvement from 2 institutions. We sought to compare the diagnostic morphology and the clinical and laboratory findings.
Results: 2 patients received renal transplants (both adults, 1 male and 1 female) and 1 heart transplant (5 years old boy). Biopsies were performed for renal failure with hematuria in 2 renal grafts and in 1 native kidney from a heart transplant recipient with a clinically stable allograft. Immuno stain (IHC) for AdV was positive in both grafts and in 1 native kidney. There was a variable degree of tubulocentric necrosis with a vaguely granulomatous mixed inflammatory infiltrate associated with rare cells with cytopathic effect. There was also lymphocytic infiltrate simutaing T-cell rejection with admixture of eosinophils. In the heart allograft, AdV was detected by IHC in the absence of necrosis. All patients had AdV (+) serology but, in 1 adult patient, the viral load was low and presumed to be clinically insignificant. 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. Detection of AdV nephritis may be associated with subclinical non-renal graft involvement. Prompt diagnosis (aided by IHC), with specific treatment, can prevent graft loss. Positive serology, with a low but detectable viral load, may be associated with clinically significant graft involvement in some patients.
Category: Kidney (does not include tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 223, Monday Afternoon