Kidney Week

Abstract: SA-PO1141

Suspected Donor-Derived Disseminated Adenovirus Disease After Simultaneous Pancreas-Kidney Transplantation

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Tiwari, Mahesh, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

Mahesh Tiwari, MD

• Tuppil, Koushik, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

Koushik Tuppil, ScM

• Majumdar, Anjali, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

Anjali Majumdar, MD

• Shah, Mital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States

Mital Shah, MD

Introduction

The majority of human adenovirus (HAdV) disease after kidney transplantation is attributed to reactivation or community-acquired disease. Suspected donor-derived adenovirus transmission after renal transplantation is rarely described. We present a case of suspected donor-derived disseminated HAdV disease after kidney-pancreas transplant successfully treated with cidofovir.

Case Description

A 53-year male (CMV IgG+/EBV IgG+) with ESRD underwent pancreas-kidney transplant from a 22-year-old deceased-donor (CMV IgG+/EBV IgG+) declared brain dead after intracranial hemorrhage without known prior flu-like or gastrointestinal symptoms. The recipient received thymoglobulin induction. On postoperative day (POD) 24, he presented for diarrhea, hematuria, fatigue, myalgias, productive cough, rhinorrhea, conjunctivitis and fever of 101° F. Creatinine was 1.8 mg/dL from 1.1-1.3 mg/dL postoperatively. ALT was 125 mg/dL. AST was 58 mg/dL. ALP was 138 mg/dL. Urinalysis had 3+ blood, 2+ protein, and 88 white blood cells. Doppler ultrasound of kidney and pancreas, chest radiograph, urine cultures and blood cultures were unremarkable. HAdV DNA was detected in a nasopharyngeal swab. The transplant team was notified by UNOS on POD 27 that the mate kidney recipient developed disseminated HAdV infection, raising concern for donor-derived transmission. Initial plasma HAdV viral load was 476,000 copies/mL. Given viremia and multi-organ involvement, weekly cidofovir 5 mg/kg with probenecid was initiated. Viremia cleared by POD 55 with 3 doses of cidofovir without nephrotoxicity. At 1-year, the patient remained free of recurrent infection with preserved baseline graft function.

Discussion

Disseminated HAdV in two kidney recipients from the same donor within the first month post-transplant strongly suggests donor-derived transmission and supports possible HAdV latency in transplanted renal tissue. Definitive confirmation would require donor and recipient whole genome sequencing and procurement biopsy with suggestive immunohistochemistry. Clinicians should consider donor-derived HAdV early in transplant recipients with suggestive clinical course when linked recipient HAdV infection is identified. It is important to consider HAdV disease in sites outside the transplanted organ. Though there are no FDA-approved antiviral treatments of HAdV infection, cidofovir with probenecid can be considered.