Abstract
BACKGROUND: Adenovirus (AdV) in solid-organ transplants (SOT) was historically associated with increased morbidity and mortality. Detection of AdV at ≥2 sites is predictive of invasive disease in other immunocompromised populations; however, data is lacking for SOT. METHODS: All SOT in children ≤18 years from January 2005 to June 2017 (n = 1,024). We evaluated host and viral risk factors associated with disseminated AdV infection (defined as AdV from ≥2 sites or DNAemia alone) and the clinical spectrum of disease. RESULTS: Ninety-two patients had 116 AdV infections. Overall prevalence was 9% with one death. Thirty-nine percent of patients had disseminated infection and of those, 44% received cidofovir. Patients with disseminated infection were more likely to be ≤2 years compared with >2 years (P = 0.003), infected in first-year post-transplant compared with >1 year (P = 0.05), and to present with fever compared with no fever (P = 0.02). No difference was observed for organ subtypes, presence of gastrointestinal or upper respiratory tract symptoms, peak DNAemia, mean viral load (mean 3.9log(10)vs. 4log(10)) between patients with dissemination compared with without dissemination. For patients who received a biopsy, dissemination was not different between patients with a positive biopsy vs. negative biopsy (46% vs. 54%). Cidofovir was given to 64% of the positive biopsy patients. No difference for age at infection or time to infection was observed between the treated and not treated groups. CONCLUSION: Our data shows that younger age at infection, shorter time to infection and clinical fever are risk factors for disseminated adenovirus infection in pediatric SOT patients, supporting primary infection and enhanced immunosuppression as main factors that allow viral dissemination. Some patients with high viral loads and biopsy-proven disease were not treated with cidofovir with very low mortality, reflecting a broader spectrum of infection than previously recognized. Our data begins to define a high-risk clinical and viral phenotype for adenovirus dissemination, which can inform management strategies. DISCLOSURES: All authors: No reported disclosures.