Successful outcome of severe adenovirus hepatitis of the allograft following liver transplantation

Abstract

Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case. Adenoviral infection of the allograft should always be considered as a differential diagnosis when clinical signs of severe hepatitis are present after liver transplantation. Accurate diagnosis with immunohistochemical detection of viral proteins in the liver graft is of paramount importance for the early diagnosis and management of this uncommon, severe, and probably underdiagnosed entity.

An interesting case of adenoviral hepatitis in a cardiac transplant recipient

“…Infection with ADV is defined as the presence of the virus on culture, of the antigen by immunoassay findings, or of viral DNA by PCR in samples obtained from body fluid or tissue, irrespective of symptoms (4). Hence, adenoviral hepatitis should be suspected in any solid organ transplant recipient with constitutional symptoms and unexplained elevation of transaminases (5).…”

Histopathological Syndromes of Liver Allograft Rejection and Recurrent Disease

“…Pathophysiology Adenoviral-related disease after liver transplantation is largely restricted to pediatric recipients with primary infections [174,175], although occasional cases have been reported in adults [176,177].…”

“…Immunohistochemical staining is usually required to confirm the diagnosis and given 52 serotypes it seems prudent to employ antibodies reactive with the hexon protein common to all serotypes of adenovirus (e.g. MAB805, blend of clones 20/11 and 2/6; CHEMICON International Inc., Temecula, California, USA) [177].…”

Adenoviral graft-nephritis: case report and review of the literature

“…Amongst transplant patients, SC and intestinal recipients are at the highest risk [3–5]; children seem to be more commonly affected [6]. The virus may be transmitted with the allograft [7]. Type of illness and adenoviral serotype vary according to the underlying disease, patient age and affected organs [8].…”