Adenoviral infections in pediatric transplant recipients: a hospital-based study

To assess the disease burden and outcomes resulting from adenoviral infections among pediatric transplant recipients.

This was a retrospective study of adenoviral infections among pediatric transplant recipients who were hospitalized at our center between 1993 and 2003. Patients were defined as having adenoviral infection if the virus was demonstrated in stool, urine, respiratory, blood, or biopsy tissue samples in the presence of attributable clinical findings. Data were obtained from the hospital's medical records and laboratory databases.

There were 55 patients with single episodes of adenovirus infection: 28 (50.9%) solid organ transplant (SOT) and 27 (49.1%) hematopoietic stem cell transplant (HSCT) recipients. The prevalence rates among SOT and HSCT recipients were 1 per 16 and 1 per 24 transplants performed, respectively. The median age of patients with adenovirus infections was 3.66 years (range, 0.25-17.25). Infection occurred at a median of 1.6 months posttransplantation (range, 0.03-153.). Adenovirus was most frequently demonstrated from the gastrointestinal tract (78%). Other sites infected included the respiratory tract, liver, blood and urinary tract. Overall mortality was 14.6%. All deaths occurred among HSCT recipients (mortality, 29.6%). Deaths were more likely among patients with adenovirus identified at >or=2 sites than in those having localized disease (P < 0.01).

Mortality from adenoviral infection was a greater risk for HSCT than SOT recipients. Early onset of infection after transplantation suggests the possibility of reactivation of adenovirus rather than new acquisition in at least of proportion of cases. This is important for surveillance of this infection in transplant recipients.