Adenovirus infections in pediatric small bowel transplant recipients.
BACKGROUND
Adenovirus is commonly isolated from pediatric small bowel transplant recipients, but its clinical consequences remain poorly understood.


METHODS
The medical records of pediatric small bowel transplant recipients transplanted between January 2003 and December 2007 were reviewed. Thymoglobulin and basiliximab induction and tacrolimus-based immunosuppression were the standard of care. Logistic regression analysis was performed to determine risk factors for infection, descriptive analysis to determine adenovirus incidence, and Kaplan-Meier curve analysis to determine the timing of events after transplantation.


RESULTS
Ninety-eight patients were included; 38 were positive for adenovirus (incidence 23.5%), 23 for viral shedding, 23 for infections. Nine infections developed in the first month after transplantation and 8 during the following 5 months. The small bowel was involved in 19 cases. Younger age at transplantation was a risk factor for adenovirus infection (odds ratio=0.81, 95% confidence interval, 0.663-0.994, P=0.04). Treatment of rejection did not increase the risk of adenovirus infection. Cytomegalovirus D+/R- sero-status was a protective factor (odds ratio=0.26, 95% confidence interval, 0.06-1.089, P=0.04).


CONCLUSIONS
Adenovirus infections affected 24% of recipients and developed mostly during the first 6 months after transplantation. Small bowel is the most frequently involved site. Younger age at transplantation is a risk factor for adenovirus infection; whereas cytomegalovirus D+/R- sero-status seems to be protective.
Florescu
Diana F
DF
Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA. dflorescu@unmc.edu
Islam
Monirul K
MK
Mercer
David F
DF
Grant
Wendy
W
Langnas
Alan N
AN
Freifeld
Alison G
AG
Sudan
Debra
D
Basappa
Rishika
R
Dimaio
Dominick
D
Kalil
Andre C
AC
D000257:Adenoviridae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D000077552:Basiliximab; D002648:Child; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D011183:Postoperative Complications / Q000821:virology; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use; D000077562:Valganciclovir; D017201:Virus Shedding
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077562:Valganciclovir; D015774:Ganciclovir; D016559:Tacrolimus