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Abstract: SA-PO382

Use of the Seraph® 100 Microbind® Affinity Blood Filter in an Adolescent Patient with Disseminated Adenoviral Disease

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Li, David S., University of Washington School of Medicine, Seattle, Washington, United States
  • Burke, Thomas Michael, University of Washington School of Medicine, Seattle, Washington, United States
  • Smith, Jodi M., University of Washington School of Medicine, Seattle, Washington, United States
  • Okamura, Daryl M., University of Washington School of Medicine, Seattle, Washington, United States
  • Menon, Shina, University of Washington School of Medicine, Seattle, Washington, United States
Introduction

Disseminated adenovirus infection can lead to high mortality and morbidity in immunocompromised patients. The Seraph® 100 Microbind® Affinity Blood Filter (Seraph 100) is a hemoperfusion device designed to adsorb pathogens when added to extracorporeal circuits. It has emergency use authorization for the treatment of COVID-19. Preclinical tests show a 62% reduction of adenoviral (ADV) load with Seraph 100, but this has not been reported in pediatrics.

Case Description

A 17 y.o. female s/p deceased donor kidney transplant (txp) for underlying FSGS, on chronic therapy with prednisone, tacrolimus, everolimus, presented 2 years post txp with dysuria, hematuria and fevers. She had AKI (creatinine of 2.3, baseline 0.8), elevated transaminases, and high serum ADV (> 10 million copies/mL). Kidney biopsy showed ADV nephritis with patchy areas of necrotizing interstitial inflammation and abundant viral inclusion bodies. Immunosuppression was discontinued but she remained febrile to 41° C, and had ADV levels >log 7 (> 10 million copies/mL). Cidofovir was not used due to AKI, and the risk of nephrotoxicity. After discussing the risks and benefits treatment with Seraph100 filter was started. She received 2 sessions in-line with continuous renal replacement therapy for a total time of 9 hours. Approximately 18 blood volumes were processed. ADV load decreased from 10 million prior to treatment to 148009 copies/mL (log 5.2) after the 2nd session. Fever curve (Fig 1) and transaminases improved. The ADV load continued to decrease despite not receiving additional sessions & restarting txp meds.

Discussion

Seraph® 100 filter was effective in reducing the ADV load in this adolescent patient with disseminated adenoviral infection post kidney txp, and led to an improvement in her clinical status. She tolerated treatment without significant adverse events.
Teaching Point: The Seraph 100 uses heparin coated beads to bind pathogens, and can help debulk the infectious load. More studies are needed in pediatrics on its efficacy.

Clinical, viral response with Seraph