Epidemiology and Outcomes of Early-onset and Late-onset Adenovirus Infections in Kidney Transplant Recipients

Background Adenovirus (ADV) infection after kidney transplantation (KT) causes significant morbidity. Patient characteristics and outcomes of ADV infection in KT recipients were investigated. Methods All adult KT recipients with ADV infection between January 2015 and June 2019 were included. ADV infection/disease was defined as detection of ADV DNA in clinical specimens/plus symptoms. Clinical and laboratory findings, treatments, and outcomes were assessed. Results ADV infection was diagnosed in 24/751 KT recipients (3.2%). Twenty (83%) were male with a median age of 47 years (IQR 36–58). Fifteen (63%) underwent deceased donor KT, and 13 (54%) received induction therapy. Twenty-one (88%) and four (17%) patients developed hemorrhagic cystitis and disseminated disease, respectively. There were equal distributions of early-onset (EOI) ( 3 months) infections. Patients who were diagnosed with EOI had lower median absolute lymphocyte counts compared to those with LOI (735/mm3 [IQR 543–1123] vs. 1122/mm3 [IQR 784–1344], p = 0.04). All achieved resolution after reduction of their immunosuppression regimen and 13 (54%) received cidofovir therapy. Eighteen (75%) developed allograft dysfunction, of which 67% were transient. One (4%) underwent nephrectomy for allograft failure and 1 (4%) died (non-ADV-related). Patients with EOI were more likely to receive cidofovir therapy (75% vs. 33%, p = 0.04) and develop other opportunistic infections (75% vs. 8%, p < 0.001). Conclusions ADV infection after KT typically involves a genitourinary system and transiently impairs an allograft function. Those who developed early infection tend to have more lymphopenia, co-infection and receiving antiviral therapy.