480. Epidemiology of Adenovirus Infection and Disease among Pediatric Solid Organ Transplant Recipients
Session: Poster Abstract Session: Pediatric Viral Infections
Thursday, October 8, 2015
Room: Poster Hall
Background:

Human adenovirus (HAdV) is associated with poor outcomes in immunosuppressed patients but data in pediatric solid organ transplant (SOT) populations are limited.  We aimed to describe the epidemiology and outcomes of HAdV in pediatric SOT recipients. 

Methods:

We retrospectively identified all SOT at The Children’s Hospital of Philadelphia between 2006 and 2013. Laboratory data were reviewed to identify specimens positive for HAdV by PCR within 180 days from transplant. HAdV disease was defined as HAdV detection plus evidence of organ dysfunction. Medication records for HAdV positive patients were reviewed for receipt of at least one dose of cidofovir. HAdV-related death was defined as declaration of HAdV disease without resolution of symptoms prior to death or evidence of HAdV pathology at autopsy.

Results:

There were 350 SOT patients with a median age of 9 years (IQR: 2 to 14) (Table). HAdV was detected in at least one specimen for 23 (6.6%) patients and was most common in lung and liver transplant recipients. Nine patients had one or more HAdV disease events: 6 pneumonitis, 3 hepatitis, and 1 colitis. Only 3 HAdV positive patients received cidofovir, including 1 patient with asymptomatic HAdV and 1 patient each with HAdV pneumonitis and hepatitis.  There were 12 (3.4%) deaths in the cohort none of which were attributed to HAdV disease. 

Conclusion:

In this pediatric SOT cohort, the detection of HAdV by PCR was infrequent at 6.6% with only 2.6% of patients meeting criteria for HAdV disease.  Cidofovir was infrequently utilized and although the comparative effectiveness of cidofovir could not be assessed, cidofovir was not necessary to resolve HAdV disease.  Future, prospective multi-center studies are needed to confirm the epidemiology of HAdV in SOT and to establish the comparative effectiveness of cidofovir in this setting. 

Table: Pediatric SOT Characteristics

Characteristic

Total

(n=350)

Lung

(n=28, 8%)

Heart/

Heart-Lung

(n=78, 22%)

Liver

(n=119, 34%)

Kidney

(n=131, 37%)

Age, years

(Median, IQR)

9 (2 to 14)

12 (5 to 15)

4 (0 to 12)

2 (1 to 7)

10 (6 to 13)

Sex, male*

 

200 (57.1)

11 (39.3)

45 (57.7)

72 (60.5)

78 (59.5)

HAdV Positive*

 

23 (6.6)

3 (10.7)

6 (7.7)

13 (10.9)

3 (2.3)

HAdV Disease*

 

9 (2.6)

2 (7.1)

3 (3.8)

4 (3.4)

1 (0.8)

*n (%)

This work was supported in part by NIH/NIAID Contract #HHSN2722011000040C.

Sarah B. Klieger, MPH1, Richard Hodinka, PhD2, Adriana Kajon, PhD3, Hans Petersen, MS4, Ana Maria Cardenas, PhD5, Jerica Gee, BFA6, Laura Smallcomb, BSN, MBE5, Evangelos Spyridakis, MD7 and Brian T. Fisher, DO, MSCE8, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)University of South Carolina School of Medicine Greenville, Greenville, SC, (3)Lovelace Respiratory Research Institute, Albuquerque, NM, (4)Infectious Disease Program, Lovelace Respiratory Research Institute, Albuquerque, NM, (5)Children's Hospital of Philadelphia, Philadelphia, PA, (6)The Children's Hospital of Philadelphia, Philadelphia, PA, (7)Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (8)Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosures:

S. B. Klieger, None

R. Hodinka, None

A. Kajon, None

H. Petersen, None

A. M. Cardenas, None

J. Gee, None

L. Smallcomb, None

E. Spyridakis, None

B. T. Fisher, Pfizer: Grant Investigator , Research grant
Merck: Grant Investigator , Research grant

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