Abstract: SA-PO1134
Non-T Cell Depleting Induction Therapy Predisposes to Early Human Adenovirus Infection as Compared with T-Cell-Depleting Therapy: Case Report and Review of Literature
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Akram, Sami M., Harbor-UCLA Medical Center, Torrance, California, United States
- Barba, Lilly M., Harbor-UCLA Medical Center, Torrance, California, United States
Group or Team Name
- Division of nephrology, HUCLA
Introduction
Human Adenovirus (HAdV) infections are increasingly recognized in post kidney transplant patients. We report a unique case of early post op HAdV infection presenting with a space occupying lesion in the allograft, evolving to bladder masses. We reviewed the literature to assess the effect of non T-cell depleting agents on frequency of early and late HAdV infection.
Case Description
A 38-year-old male, with end stage kidney disease (ESKD) due to IgA nephropathy underwent deceased donor renal transplant (DDRT). He received induction with Basiliximab. Post op course was uneventful. On post op day 8 he was admitted with fever (39.2 deg. C) and diarrhea of 2 days duration. Upon review of systems he had mild cough with mucoid sputum. On exam, he was tachycardiac with no allograft tenderness. Rest of the physical exam was unremarkable. Cellcept was held. The BioFire Film Array was positive for adenovirus. There was no viremia. He was lymphopenic and serum creatinine rose from 0.9 to 1.2 mg/dL. Colonoscopic biopsy showed microscopic colitis. Ultrasound showed a space occupying lesion in the upper pole of the allograft and a mass in the bladder. Fever resolved on hospital day 8 without additional interventions. Cystoscopy revealed multiple masses in the bladder and in the ureter. Bladder biopsy was consistent with cystitis cystica glandularis.
Discussion
Non T-cell depleting agents prevent further T cell mediated immune responses while allowing other cell surface protein receptors such as CD48, CD80, and CTLA4, to be available for adenoviral entry. This causes the host to be vulnerable to viral entry in the early post-transplant period. Adenovirus integrates into the DNA, producing harmful proteins causing cellular injury and tumorogenesis. Literature review supports that early HAdV infections occur predominantly in patients who received non T-cell depleting induction therapy (Table 1.)
Therefore,a high index of suspicion for HAdV infection should be maintained in febrile patients who receive non T-cell depleting induction therapy.
Table 1: Induction Therapy and Pattern of HAdV infection.
| Basiliximab / Daclizumab | T-cell Depleting Agents | |
| Early Infections (4wks +/- 2 wks.) | 13 | 3 |
| Late Infections | 1 | 9 |
P value = 0.00039; Result is significant at P <0.05.