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Kidney Week

Abstract: PO2446

Disseminated Adenovirus Treated with Brincidofovir in a Kidney Transplant Recipient

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Truong, Tiffany, University of Southern California, Los Angeles, California, United States
  • Cao, Thanh, University of Southern California, Los Angeles, California, United States
  • Voora, Santhi, University of Southern California, Los Angeles, California, United States
  • Maw, Thin Thin, University of Southern California, Los Angeles, California, United States
Introduction

Adenovirus is a common viral infection, with which immunocompromised patients have an increased risk of disseminated disease. It is less frequently described in solid organ transplant recipients and the optimal therapy for disseminated disease is unknown. We present a case of disseminated adenovirus in a kidney transplant recipient who was treated successfully with brincidofovir.

Case Description

A 56 year old female with ESRD of unclear etiology received her second kidney transplant from a deceased donor 2 years ago with thymoglobulin induction. She presented with one day of gross hematuria and right flank pain, as well as 2 weeks of malaise and 5 days of fever, cough, sore throat, nausea and vomiting. She had acute kidney injury with creatinine of 1.75 mg/dl from a baseline of 0.8 mg/dl. She was found to have adenovirus in urine (>2million) and serum. Other infectious etiologies were ruled out.
Initial treatment consisted of reduced immunosuppression with discontinuation of mycophenolate mofetil and tacrolimus and increased prednisone from 5mg to 10mg daily due to leukopenia. Given disseminated symptoms, adjunctive treatment was also initiated with cidofovir 1mg/kg IV q48hr alternating with IVIG 500mg/kg q48 hr. She received 4 doses of cidofovir and IVIG, with resolution of hematuria and decreased adenovirus level in urine. Although she received hydration before and after cidofovir, creatinine rose to 2.04 mg/dl. With 2 additional cidofovir doses, she continued to have AKI (peak 3.1 mg/dl), before brincidofovir was started at a dose of 100mg twice weekly. Creatinine was 2.73 mg/dl when initiated on brincidofovir which decreased and stabilized to 2.2 mg/dl. Brincidofovir was discontinued when adenovirus was undetected in serum and <500 copies/ml in urine.

Discussion

The most commonly used adjunctive treatment to reduced immunosuppression in the treatment of adenovirus infection is cidofovir. However, cidofovir is nephrotoxic and renally cleared. This may limit its use, particularly in kidney transplant patients. Brincidofovir is less nephrotoxic due to decreased accumulation in proximal tubules, and may be better tolerated in kidney transplant recipients. We report a case of well tolerated brincidofovir treatment of disseminated adenovirus infection in a kidney transplant recipient who demonstrated clearance of infection and improvement in kidney function.