Intravenous Cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient.
BACKGROUND
No definitive antiviral therapy exists for adenovirus (ADV) in immunosuppressed hosts. Cidofovir (CDV), a broad spectrum anti-DNA viral agent, has previously been shown to be of therapeutic benefit in life-threatening adenoviral disease in bone marrow stem-cell recipients.


METHODS
A 71/2-month-old girl with a history of biliary atresia developed fevers, hematochezia, tachypnea, and laboratory evidence of hepatitis and pancreatitis 12 days after liver transplantation. A stool culture, oropharyngeal culture, blood viral culture, and blood polymerase chain reaction (PCR) confirmed ADV. Cidofovir 1 mg/kg intravenously three times per week was initiated. The patient received intravenous hydration and probenecid with the infusions to reduce the nephrotoxicity of CDV. Immunosuppression was reduced to achieve tacrolimus trough levels of approximately 8 ng/mL and prednisone at 0.1 mg/kg per day. Complete blood cell count, urinalysis, and viral studies were obtained weekly.


RESULTS
Detection of ADV DNA by PCR made a transition from positive to negative during CDV therapy. Blood viral cultures became negative after two CDV doses. Alanine aminotransferase normalized by 5 weeks of therapy. CDV was discontinued after 7 weeks secondary to transient acidosis and proteinuria. The patient never developed azotemia, neutropenia, or ocular abnormalities.


CONCLUSIONS
CDV was associated with improved clinical status, viral clearance, and minimal transient side effects in a pediatric liver transplant recipient with disseminated adenoviral disease. The current report documents clearance of disseminated ADV infection in a liver transplant recipient receiving CDV infusions.
Carter
Beth A
BA
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Karpen
Saul J
SJ
Quiros-Tejeira
Ruben E
RE
Chang
I-Fen
IF
Clark
Brenda S
BS
Demmler
Gail J
GJ
Heslop
Helen E
HE
Scott
Jaymee D
JD
Seu
Philip
P
Goss
John A
JA
D000256:Adenoviridae / Q000235:genetics / Q000302:isolation & purification; D000257:Adenoviridae Infections / Q000188:drug therapy*; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001769:Blood / Q000821:virology; D002648:Child; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000008:administration & dosage* / Q000627:therapeutic use
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000410:Alanine Transaminase; D000077404:Cidofovir