The Outcomes of Adenovirus Infection in Kidney Transplant Recipients.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-11-16 DOI:10.1111/tid.14409

Hay Me Me, Sumi Nair, Carrie A Schinstock, Tambi Jarmi, Nan Zhang, Pooja Budhiraja, Lavanya Kodali, Holenarasipur R Vikram, Girish Mour

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引用次数: 0

Abstract

Background: Adenovirus (ADV) infection can lead to significant morbidity and mortality in immunocompromised patients, particularly in those with hematopoietic stem cells or solid organ transplants. The incidence of ADV infection in kidney transplant (KT) is not well-defined as ADV is often asymptomatic and not routinely checked.

Methods: This retrospective case-series study included KT and simultaneous pancreas-KT (SPKT) recipients from January 1, 2008, to January 31, 2024, across three Mayo Clinic sites (Arizona, Florida, and Minnesota) with symptomatic adenovirus polymerase chain reaction cases. The primary outcomes were allograft function at various intervals post-ADV infection, allograft, and patient survival.

Results: We report one of the largest multi-site case series regarding outcomes of ADV in KT with 17 patients. The median time to ADV infection was 30 weeks (5-74). Five patients (29%) developed disseminated infection. Nine patients (53%) of the entire cohort experienced graft loss within a median of 35 (4-168) weeks, with four (44%) of graft loss attributed to ADV. Nine patients (53%) developed rejections post-ADV infection with a median of 4 (2-8) weeks after resolution. One patient died from acute hypoxic respiratory failure from ADV infection.

Conclusion: ADV should be considered in KT/SPKT patients with renal dysfunction, hematuria, and with or without fever. Despite the low mortality rate, there is a significant risk of graft loss and rejection after ADV infection. It is crucial to screen for ADV and develop intervention strategies for treatment. Further multicenter studies are needed to better define, stage, and manage ADV infection.

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肾移植受者感染腺病毒的结果。

背景：腺病毒（ADV）感染可导致免疫功能低下患者，尤其是造血干细胞或实体器官移植患者的重大发病率和死亡率。肾移植（KT）中ADV感染的发病率尚不明确，因为ADV通常没有症状，也没有进行常规检查：这项回顾性病例系列研究纳入了 2008 年 1 月 1 日至 2024 年 1 月 31 日期间梅奥诊所三个地点（亚利桑那州、佛罗里达州和明尼苏达州）有症状腺病毒聚合酶链反应病例的 KT 和同步胰腺-KT（SPKT）受者。主要结果是ADV感染后不同时间段的异体移植功能、异体移植和患者存活率：我们报告了有关 KT 中 ADV 治疗效果的最大规模多站点病例系列之一，共有 17 名患者。ADV感染的中位时间为30周（5-74周）。五名患者（29%）出现播散性感染。在中位 35 周（4-168 周）内，9 名患者（53%）出现移植物缺失，其中 4 名患者（44%）的移植物缺失归因于 ADV。9名患者（53%）在ADV感染后出现排斥反应，中位数为4（2-8）周后缓解。一名患者死于ADV感染引起的急性缺氧性呼吸衰竭：结论：肾功能不全、血尿、发热或不发热的 KT/SPKT 患者应考虑 ADV。尽管死亡率较低，但感染 ADV 后，移植物丢失和排斥反应的风险很大。筛查 ADV 并制定干预治疗策略至关重要。需要进一步开展多中心研究，以更好地定义、分期和管理 ADV 感染。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.