Epidemiology and Outcomes of Early-onset and Late-onset Adenovirus Infections in Kidney Transplant Recipients

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Adenovirus (ADV) infection after kidney transplantation (KT) causes significant morbidity. Patient characteristics and outcomes of ADV infection in KT recipients were investigated.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All adult KT recipients with ADV infection between January 2015 and June 2019 were included. ADV infection/disease was defined as detection of ADV DNA in clinical specimens/plus symptoms. Clinical and laboratory findings, treatments, and outcomes were assessed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>ADV infection was diagnosed in 24/751 KT recipients (3.2%). Twenty (83%) were male with a median age of 47 years (IQR 36–58). Fifteen (63%) underwent deceased donor KT, and 13 (54%) received induction therapy. Twenty-one (88%) and four (17%) patients developed hemorrhagic cystitis and disseminated disease, respectively. There were equal distributions of early-onset (EOI) (< 3 months) and late- onset (LOI) (> 3 months) infections. Patients who were diagnosed with EOI had lower median absolute lymphocyte counts compared to those with LOI (735/mm3 [IQR 543–1123] vs. 1122/mm3 [IQR 784–1344], p = 0.04). All achieved resolution after reduction of their immunosuppression regimen and 13 (54%) received cidofovir therapy. Eighteen (75%) developed allograft dysfunction, of which 67% were transient. One (4%) underwent nephrectomy for allograft failure and 1 (4%) died (non-ADV-related). Patients with EOI were more likely to receive cidofovir therapy (75% vs. 33%, p = 0.04) and develop other opportunistic infections (75% vs. 8%, p < 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>ADV infection after KT typically involves a genitourinary system and transiently impairs an allograft function. Those who developed early infection tend to have more lymphopenia, co-infection and receiving antiviral therapy.</jats:p> </jats:sec>