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Adenovirus Disease Following Pediatric Liver Transplantation: 10-Year Experience From a Large Pediatric Transplant
Anna M Banc-Husu1, Sara Hassan2, N Thao N Galvan3
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Insights
Human adenovirus infection is common and serious in pediatric liver transplant recipients, especially within 30 days post-transplant. Early antiviral management guidance is urgently needed for better outcomes.
Area of Science:
- Pediatric Hepatology
- Infectious Diseases
- Transplantation Immunology
Background:
- Human adenovirus poses a life-threatening risk to immunocompromised individuals.
- Pediatric liver transplant recipients are particularly vulnerable to severe adenovirus infections.
Purpose of the Study:
- To determine the prevalence, clinical presentation, and treatment outcomes of adenovirus infection in children following liver transplantation.
- To identify risk factors and optimal management strategies for adenovirus disease in this population.
Main Methods:
- A retrospective cohort study was conducted from 2013 to 2022.
- Data on adenovirus infection incidence, clinical characteristics, and outcomes were analyzed in post-transplant pediatric patients.
- Patients were compared based on adenovirus treatment status.
Main Results:
- Adenovirus disease occurred in 26% of pediatric liver transplant patients, with 40% diagnosed within 30 days post-transplant.
- Fever, gastrointestinal symptoms, and hepatitis were common presentations; 24% experienced disseminated disease.
- Cidofovir-treated patients had higher viral loads and mortality compared to untreated patients.
Conclusions:
- Symptomatic and disseminated adenovirus disease is highly prevalent in pediatric liver transplant recipients, especially early post-transplant.
- Current treatment approaches, including cidofovir, are associated with high viral loads and mortality.
- Evidence-based guidelines are critically needed for the early antiviral management of adenovirus disease in this vulnerable group.
Background:
Human adenovirus in immunocompromised patients can be life-threatening. We describe the prevalence, clinical presentation, and treatment of adenovirus after pediatric liver transplantation at a large transplant center.
Methods:
We performed a retrospective cohort study of adenovirus infection in children from 2013 to 2022. We compared incidence, clinical characteristics, and outcomes of post-transplant children by adenovirus treatment status.
Results:
Adenovirus disease developed in 26% (84/320) children after liver transplant. Median age at liver transplant was 17.5 months, 48% were female; 50% had biliary atresia. Fever (53%), gastrointestinal symptoms (48%), and hepatitis (41%) were the most common clinical presentations at diagnosis. Median time to adenovirus diagnosis was 80 days (IQR 19-260) with 40% (n = 31/84) identified within 30 days post-transplant. Disseminated adenovirus (≥ 2 organ involvement) occurred in 24% (20/84). Fourteen patients (17%) received cidofovir, and most (13/14, 93%) had DNAemia, compared to 57% untreated patients with DNAemia (p = 0.013). Median peak adenovirus load was 491 805 copies/mL (IQR 24 800-1 900 000) in treated vs. 1000 copies/mL (IQR 595-794 794) in untreated patients (p < 0.001). Overall mortality was 8% (7/84).
Conclusion:
The incidence of symptomatic and disseminated adenovirus disease was high in our pediatric liver transplant patients, particularly within 30 days post-transplant. Patients who received cidofovir treatment presented with high viral load and had the highest mortality. There is a critical need for evidence-based guidance for early antiviral management of adenovirus disease after pediatric liver transplant.
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