Jafri S, Segovia M, and Weiner J. A multicenter evaluation of the diagnosis, management and outcomes of adenovirus enteritis infection following intestine or multivisceral transplant. Transplantation 2021; 105(7 SUPPL 1):S81.
Introduction: Adenovirus Enteritis (AE) is a unique infection which can complicate patient course following intestine and multivisceral transplantation. Solid organ transplant patients have an increased risk for infection and intestine and multivisceral patients are unique in that they often develop inflammation from rejection in the intestine which might predispose to infection.
Methods: We reviewed patients who received an intestine transplant at three academic transplant centers between 2010 and 2020 for demographic, laboratory and clinical data.
Results: Five patients were identified with diagnosis of adenovirus enteritis. Three patients (60%) had isolated intestine transplant while two underwent multivisceral transplantation. Reason for transplant included trauma, volvulus, intestinal atresia and visceral neuropathy. All patients received induction with anti-thymocyte globulin (80%) or basiliximab. The initial diagnosis of infection occurred at a mean of 26.8 months following transplant (range 2-68 months). Diagnosis was by polymerase chain reaction (PCR) measurement in plasma (80%), intestine or stool. Cidofovir was used in 100% of cases as primary management. 40% of patients had reduction of immunosuppression at the time of diagnosis while the remainder did not. 60% of patients had rejection within a month prior to diagnosis. No patients had recurrent rejection in the month following treatment. Two patients had recurrent infection. No patients had graft loss or death within 6 months of infection. Two patients had enterectomy at a mean of 29.5 months after infection (range 22-37 months) Three patients died at a mean of 32 months following diagnosis (range 8-51 months).
Conclusion: We present a series of five cases of adult patients with AE following intestinal and multivisceral transplant. AE may arise due to immunosuppression, vascular compromise of the transplanted organ, or a combination of factors. Our study supported rejection as a risk factor for infection. Graft loss or death was not seen within 6 months following infection.
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