Prospective Assessment of Adenovirus Infection in Pediatric Kidney Transplant Recipients.

Background: Adenovirus infection is associated with graft dysfunction and graft loss in in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. Methods: We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. Results: Adenovirus viremia was detected in eleven (14.7%) patients at a median onset of 173 (IQR 109-310) days posttransplant; six (8%) had asymptomatic viremia and five (6.7%) had symptomatic disease (2 with hematuria and 3 with an acute febrile respiratory illness). Viremic patients did not differ from nonviremic patients in age, immunosuppression management, or CMV or EBV serostatus, but were more likely to develop CMV viremia during the first 2 years posttransplant. No patient had an increase in creatinine from baseline during the time of adenovirus viremia. In a Cox proportional hazards regression, subclinical adenovirus viremia was not associated with a faster time to a 30% decline in eGFR. Conclusion: Adenovirus infection is common among pediatric kidney transplant recipients and frequently causes symptomatic disease; however, symptoms are often mild and are not associated with a decline in graft function. Routine monitoring for adenovirus viremia in pediatric kidney transplant recipients may not be warranted. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

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