Adenovirus In Solid Organ Transplant Recipients
Publication Date: April 1, 2019
Last Updated: March 14, 2022
Recommendations
DIAGNOSTIC STRATEGIES
Surveillance testing for adenovirus should not be performed in asymptomatic SOT recipients. (Low, Strong)
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Detection of adenovirus by culture or PCR testing should be correlated with clinical symptoms, detection of the virus from other sites, and histopathologic findings to establish whether disease is present. (Low, Strong)
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Testing of serial quantitative PCR may assist in the decision to initiate therapy and in monitoring response to therapy as there is not an established threshold value at which to start therapy. (Low, Weak)
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Histopathologic analysis of biopsy samples demonstrating evidence of adenovirus disease remains the gold standard for diagnosis. (High, Strong)
Immunohistochemical staining for adenovirus may be useful to distinguish infection from rejection.
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PCR‐based testing on blood, stool, or respiratory secretions, as appropriate, should be used to detect adenovirus when histopathologic diagnosis is not possible. (Moderate, Strong)
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Assessment of a patient's adenovirus‐specific immune response may help gauge the need for adenovirus therapy in the future. (, )
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TREATMENT
Reduction of immunosuppressive regimen, if possible, should be the initial approach in the treatment of adenovirus infections. (Moderate, Strong)
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Cidofovir should be considered as the preferred antiviral agent for the treatment of adenovirus disease. (Low, Strong)
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should be administered to minimize the risk of nephrotoxicity. The ideal dose and frequency of cidofovir administration is not known.
Dose adjustment should be performed for renal insufficiency. (Moderate, Strong)
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If indicated, antiviral treatment should be continued until complete resolution of the symptoms and documentation of three negative adenovirus samples from the sites that were originally positive. (Moderate, Strong)
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Administration of cidofovir for asymptomatic adenovirus infection is not usually necessary, and the risk of nephrotoxicity should be weighed against the risk of disease progression. (Low, Strong)
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Ribavirin and ganciclovir are not recommended for the treatment of adenovirus infections. (Very Low, Strong)
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Nitazoxanide might be a therapeutic option for adenovirus enteritis in solid organ transplant recipients. (Low, Weak)
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Intravenous immunoglobulins might be beneficial, mainly in selected group of patients with hypogammaglobulinemia. (Low, Weak)
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Adoptive T‐cell therapy is a promising emerging option, but there are no data yet to support its use in SOT recipients. (, )
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PREVENTION
Contact and droplet precautions are recommended during hospitalization. (High, Strong)
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The duration of contact and droplet precautions in immunocompromised hosts might need to be extended due to prolonged shedding of the adenovirus. (Low, Weak)
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Title
Adenovirus In Solid Organ Transplant Recipients
Authoring Organization
American Society of Transplantation
Publication Month/Year
April 1, 2019
Last Updated Month/Year
December 2, 2022
External Publication Status
Published
Country of Publication
US
Document Objectives
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation.
Target Patient Population
Solid organ transplant patients
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D014180 - Transplantation, D019737 - Transplants, D000998 - Antiviral Agents, D016377 - Organ Transplantation, D000260 - Adenoviruses, Human, D000257 - Adenoviridae Infections
Keywords
antiviral, prevention, infection, solid organ transplant, adenovirus
Source Citation
Florescu, DF, Schaenman, JM; on behalf of the AST Infectious Diseases Community of Practice. Adenovirus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13527.