Adenovirus Infection of the Renal Allograft With Sparing of Pancreas Graft Function in the Recipient of a Combined Kidney-Pancreas Transplant

Sc, Mathur; Ec, Squiers; Ah, Tatum; Fs, Szmalc; Jw, Daucher; Dm, Welker; Pf, Shanley

doi:10.1097/00007890-199801150-00027

Cited by 23 publications

(14 citation statements)

References 17 publications

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“…Hemorrhagic cystitis, nephritis, pneumonia, hepatitis, enterocolitis, and disseminated disease have been described among solid-organ transplant recipients [46][47][48][49][50][51][52][53][54][55][56]. In liver transplant recipients, infection with adenovirus serotype 5 typically results in hepatitis, with a median time to onset of 55 days [25,26], whereas serotypes 1 and 2 are more commonly associated with pneumonia.…”

Section: Clinical Presentationmentioning

confidence: 99%

Emerging Infections: Adenovirus Infections in Transplant Recipients

2006

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Adenoviruses are increasingly recognized as contributors to morbidity and mortality among stem cell and solid-organ transplant recipients. Clinical presentations range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. The limited clinical data available support the use of cidofovir for many of these illnesses. Prospective studies are needed to better understand the pathogenesis of and therapeutic options for adenoviral infections in this patient population.

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Section: Clinical Presentationmentioning

confidence: 99%

Emerging Infections: Adenovirus Infections in Transplant Recipients

2006

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“…Information on the distribution of adenovirus in different compartments of the kidney is limited. Both cortex and medulla were involved in the case presented, although infection limited to the medulla has also been reported (28). Documentation of adenovirus infection in biopsy tissue is achieved by immunohistochemistry or in situ hybridization.…”

Section: Diagnosis Of Adenovirus Nephritismentioning

confidence: 87%

A Case of Late Kidney Allograft Failure

Randhawa

Mannon

2012

Clinical Journal of the American Society of Nephrology

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“…Th e urinary tract predilection of this virus is noteworthy; our patient had no signs of pancreas rejection or viral infection, with euglycemia and normal pancreatic enzyme levels. Pancreatic grafts have also been spared in two other reported cases of adenovirus infection in SKP recipients (11,12).…”

Section: Discussionmentioning

confidence: 99%

“…However, adenovirus infection has rarely been reported in SKP recipients (11,12). Presentation beyond 1 year after SKP is extremely rare, as only one reported case of adenovirus infection 18 months after transplantation has been reported (12).…”

Section: Discussionmentioning

confidence: 99%

Late Presentation of Adenovirus-Induced Hemorrhagic Cystitis and Ureteral Obstruction in a Kidney-Pancreas Transplant Recipient

Klein¹,

Kuperman²,

Haley³

et al. 2015

Baylor University Medical Center Proceedings

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We report a late presentation of adenovirus-induced renal allograft and bladder infection causing azotemia and hemorrhagic cystitis in a patient 5 years after simultaneous kidney-pancreas transplantation. Adenovirus has been increasingly recognized as a cause of morbidity and mortality in both solid organ and stem cell transplant recipients. We wish to emphasize the importance of early detection, as treatment options involve reduction of immunosuppression, followed by the addition of antiviral agents and supportive care.A denovirus causes 5% to 10% of all childhood febrile illnesses, and the immunocompetent host generally endures a mild, self-limited upper respiratory tract infection. Adenovirus then establishes latent infection in the lymphoepithelial tissues (1). In immunocompromised hosts, the clinical manifestations of adenovirus reactivation or de novo infection can range from asymptomatic to fatal. Adenovirus is identifi ed as a late complication of bone marrow transplantation with hemorrhagic cystitis, and it is increasingly recognized as a serious, though rare, adverse complication of solid organ transplantation. We describe a rare late presentation of hemorrhagic cystitis and signifi cant renal allograft dysfunction with ureteral obstruction in a patient who had undergone simultaneous kidney-pancreas transplantation (SKP) nearly 5 years earlier. With adenovirus detected in the urine, blood, and renal allograft, the patient was treated with reduction of immunosuppression, intravenous immunoglobulin, and cidofovir. Renal function did not improve despite treatment. Pancreas function, as in rare case reports, was preserved, suggesting tropism of the adenovirus. CASE DESCRIPTIONA 45-year-old African American woman had a past medical history of type 1 diabetes mellitus complicated by peripheral neuropathy, retinopathy, and end-stage renal disease. She underwent SKP in February 2009 and received daclizumab induction per protocol. Th e donor was a 2/6 human leukocyte antigen match, and both donor and recipient were cytomegalovirus positive. Th e transplant was complicated by cellular rejection of the kidney in March 2009 treated with Solu-Medrol and biopsy-proven pancreas rejection treated with 10 doses of muromonab-CD3. Renal function stabilized with a creatinine of 1.4 mg/dL. Maintenance immunosuppression included azathioprine 100 mg daily, prednisone 5 mg daily, and tacrolimus 4 mg twice daily.Five years after transplant, the patient presented with a 1-week history of fever, suprapubic pain, and nausea, with the development of hematuria 3 days later. She had presented to an emergency department for presumed urinary tract infection 3 days before admission and was treated with nitrofurantoin. However, she developed worsening hematuria and presented to the transplant clinic. She denied sick contacts and had been compliant with all medications. On examination, she had orthostatic hypotension and fever. She was pale and appeared acutely ill. Th e left lower quadrant and suprapubic area were tender without rebound...

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Adenovirus Infection of the Renal Allograft With Sparing of Pancreas Graft Function in the Recipient of a Combined Kidney-Pancreas Transplant

Cited by 23 publications

References 17 publications

Emerging Infections: Adenovirus Infections in Transplant Recipients

Emerging Infections: Adenovirus Infections in Transplant Recipients

A Case of Late Kidney Allograft Failure

Late Presentation of Adenovirus-Induced Hemorrhagic Cystitis and Ureteral Obstruction in a Kidney-Pancreas Transplant Recipient

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