398. Short Course Cidofovir (CDV) is a Feasible Option for Treatment of Adenovirus (ADV) Nephropathy in Select Solid Organ Transplant Recipients
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Potential nephrotoxicity from the treatment of adenoviral infection in renal and liver transplant recipients is concerning. The recommended treatment for ADV disease is an induction regimen of IV Cidofovir 5mg/kg weekly for 2 consecutive weeks, followed by maintenance every other week, until 3 consecutive ADV negative samples have been achieved. Although this regimen is coadministered with hydration and oral probenecid (1gm /m2 2 hours before CDV infusion and then 500mg/m2 2 and 8 hours after infusion) to reduce accumulation of Cidofovir in proximal tubular cells, this strategy still confers considerable risk of proximal tubular cell damage and hence has been contraindicated for a creatinine clearance less than 55mL/min.
We report the successful treatment of four solid organ recipients with ADV infection employing short course IV Cidofovir
Methods: We analyzed charts of four solid organ recipients (three renal transplants & one liver transplant recipient) who presented with fever, hematuria and acute renal failure (CrCl < 55ml/min) and hemorrhagic cystitis. Adenoviral disease was confirmed by positive identification of one or more of the following: isolation of adenovirus by PCR in blood and/or urine, and/or histopathologic confirmation of adenoviral disease in renal allograft tissue with a characteristic necrotizing tubulointerstitial nephritis.
Results: All four patients received 2 doses (induction only) of IV cidofovir at 5mg/kg (dose adjusted for renal failure - 1mg/kg for creatinine clearance less than 10ml/ min; 2.5 mg/kg for CrCl of 10-15ml/ min). Oral probenecid was coadministered in the manner noted above. All patients had rapid resolution of fever, hematuria and acute renal failure and were monitored serially for clearance of ADV from serum or urine by ADV PCR assay. No patient developed Cidofovir nephrotoxicity and each remains disease free after one year of follow up.
Conclusions: Although larger studies are warranted our study illustrates short course of Cidofovir appears to be an effective and safe treatment option for ADV nephropathy, despite the potential for nephrotoxicity
Senu Apewokin, MD1, Mary Prendergast, MD2, Brian Quinn, MD2 and  S. K. Apewokin, None..
B. D. Quinn, None..
M. B. Prendergast, None., (1)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (2)UNIVERSITY OF ALABAMA AT BIRMINGHAM, Birmingham, AL