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Abstract: SA-PO705

Adenovirus Immunohistochemistry in Renal Transplantation

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Wester Trejo, Maria, Leiden University Medical Center, Leiden, Netherlands
  • Feltkamp, Mariet, Leiden University Medical Center, Leiden, Netherlands
  • Wessels, Els, Leiden University Medical Center, Leiden, Netherlands
  • Bruijn, Jan A., Leiden University Medical Center, Leiden, Netherlands
  • Baelde, Hans J., Leiden University Medical Center, Leiden, Netherlands
  • Bajema, Ingeborg M., Leiden University Medical Center, Leiden, Netherlands
Background

Human adenovirus, a linear double-stranded DNA virus, is a common cause of mild respiratory and gastrointestinal disease in otherwise healthy people. In immunocompromised patients, such as renal transplant patients, it may cause severe infections including hemorrhagic cystitis, hepatitis and interstitial nephritis. Adenovirus immunohistochemistry is a technique frequently used in the clinic to aid the diagnosis of adenovirus infections, next to PCR. Based on clinical experience, we recently questioned the specificity of immunohistochemical adenovirus detection in renal tissue as currently used in laboratories worldwide.

Methods

Adenovirus immunohistochemistry was performed on 25 pre-transplantation biopsies of donor kidneys, eight autopsy controls and one renal allograft which was removed as a result of renal failure caused by infection. Adenovirus PCR targeting Adenovirus species A, B, C, E and F was performed in quadruple on those biopsies staining positive for adenovirus. In addition, electron microscopy was performed on the renal allograft.

Results

The renal allograft and 4 out of 25 pre-transplantation kidney biopsies were positive for adenovirus on immunohistochemistry, showing typical nuclear and perinuclear staining in tubular epithelium as previously reported in the literature. However, adenovirus PCR remained negative in all cases. Electron microscopy of the renal allograft showed particles with a width ranging from 75 to 95 nm, which could be compatible with adenovirus virions.

Conclusion

In cases in which adenovirus infection is clinically suspected and a positive immunohistochemical staining for adenovirus supports this notion, an additional workup (PCR and/or EM) is usually not performed. It appears that by immunohistochemistry, positivity for adenovirus is present in normal donor kidney samples without clinical suspicion for adenovirus infection. Because of lack of confirmation by PCR, we question whether immunohistochemistry for adenovirus is specific and clinically relevant. Alternatively, adenovirus could be present (latently?) in the otherwise healthy population – but little is known about its prevalence.