Intravenous cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient

Beth A. Carter, Saul J. Karpen, Ruben Quiros, I. Fen Chang, Brenda S. Clark, Gail J. Demmler, Helen E. Heslop, Jaymee D. Scott, Philip Seu, John A. Goss

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Abstract

Background. No definitive antiviral therapy exists for adenovirus (ADV) in immunosuppressed hosts. Cidofovir (CDV), a broad spectrum anti-DNA viral agent, has previously been shown to be of therapeutic benefit in life-threatening adenoviral disease in bone marrow stem-cell recipients. Methods. A 71/2-month-old girl with a history of biliary atresia developed fevers, hematochezia, tachypnea, and laboratory evidence of hepatitis and pancreatitis 12 days after liver transplantation. A stool culture, oropharyngeal culture, blood viral culture, and blood polymerase chain reaction (PCR) confirmed ADV. Cidofovir 1 mg/kg intravenously three times per week was initiated. The patient received intravenous hydration and probenecid with the infusions to reduce the nephrotoxicity of CDV. Immunosuppression was reduced to achieve tacrolimus trough levels of approximately 8 ng/mL and prednisone at 0.1 mg/kg per day. Complete blood cell count, urinalysis, and viral studies were obtained weekly. Results. Detection of ADV DNA by PCR made a transition from positive to negative during CDV therapy. Blood viral cultures became negative after two CDV doses. Alanine aminotransferase normalized by 5 weeks of therapy. CDV was discontinued after 7 weeks secondary to transient acidosis and proteinuria. The patient never developed azotemia, neutropenia, or ocular abnormalities. Conclusions. CDV was associated with improved clinical status, viral clearance, and minimal transient side effects in a pediatric liver transplant recipient with disseminated adenoviral disease. The current report documents clearance of disseminated ADV infection in a liver transplant recipient receiving CDV infusions.

Original languageEnglish (US)
Pages (from-to)1050-1052
Number of pages3
JournalTransplantation
Volume74
Issue number7
DOIs
StatePublished - Oct 15 2002

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Adenoviridae
Pediatrics
Liver
Blood Cell Count
Therapeutics
Eye Abnormalities
Azotemia
Adenoviridae Infections
Tachypnea
Biliary Atresia
Probenecid
Polymerase Chain Reaction
Urinalysis
Gastrointestinal Hemorrhage
cidofovir
Transplant Recipients
Viral DNA
Immunocompromised Host
Tacrolimus
DNA-Directed DNA Polymerase

ASJC Scopus subject areas

  • Transplantation

Cite this

Carter, B. A., Karpen, S. J., Quiros, R., Chang, I. F., Clark, B. S., Demmler, G. J., ... Goss, J. A. (2002). Intravenous cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient. Transplantation, 74(7), 1050-1052. https://doi.org/10.1097/00007890-200210150-00027

Intravenous cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient. / Carter, Beth A.; Karpen, Saul J.; Quiros, Ruben; Chang, I. Fen; Clark, Brenda S.; Demmler, Gail J.; Heslop, Helen E.; Scott, Jaymee D.; Seu, Philip; Goss, John A.

In: Transplantation, Vol. 74, No. 7, 15.10.2002, p. 1050-1052.

Research output: Contribution to journalArticle

Carter, BA, Karpen, SJ, Quiros, R, Chang, IF, Clark, BS, Demmler, GJ, Heslop, HE, Scott, JD, Seu, P & Goss, JA 2002, 'Intravenous cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient', Transplantation, vol. 74, no. 7, pp. 1050-1052. https://doi.org/10.1097/00007890-200210150-00027
Carter, Beth A. ; Karpen, Saul J. ; Quiros, Ruben ; Chang, I. Fen ; Clark, Brenda S. ; Demmler, Gail J. ; Heslop, Helen E. ; Scott, Jaymee D. ; Seu, Philip ; Goss, John A. / Intravenous cidofovir therapy for disseminated adenovirus in a pediatric liver transplant recipient. In: Transplantation. 2002 ; Vol. 74, No. 7. pp. 1050-1052.
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AU - Carter, Beth A.

AU - Karpen, Saul J.

AU - Quiros, Ruben

AU - Chang, I. Fen

AU - Clark, Brenda S.

AU - Demmler, Gail J.

AU - Heslop, Helen E.

AU - Scott, Jaymee D.

AU - Seu, Philip

AU - Goss, John A.

PY - 2002/10/15

Y1 - 2002/10/15

N2 - Background. No definitive antiviral therapy exists for adenovirus (ADV) in immunosuppressed hosts. Cidofovir (CDV), a broad spectrum anti-DNA viral agent, has previously been shown to be of therapeutic benefit in life-threatening adenoviral disease in bone marrow stem-cell recipients. Methods. A 71/2-month-old girl with a history of biliary atresia developed fevers, hematochezia, tachypnea, and laboratory evidence of hepatitis and pancreatitis 12 days after liver transplantation. A stool culture, oropharyngeal culture, blood viral culture, and blood polymerase chain reaction (PCR) confirmed ADV. Cidofovir 1 mg/kg intravenously three times per week was initiated. The patient received intravenous hydration and probenecid with the infusions to reduce the nephrotoxicity of CDV. Immunosuppression was reduced to achieve tacrolimus trough levels of approximately 8 ng/mL and prednisone at 0.1 mg/kg per day. Complete blood cell count, urinalysis, and viral studies were obtained weekly. Results. Detection of ADV DNA by PCR made a transition from positive to negative during CDV therapy. Blood viral cultures became negative after two CDV doses. Alanine aminotransferase normalized by 5 weeks of therapy. CDV was discontinued after 7 weeks secondary to transient acidosis and proteinuria. The patient never developed azotemia, neutropenia, or ocular abnormalities. Conclusions. CDV was associated with improved clinical status, viral clearance, and minimal transient side effects in a pediatric liver transplant recipient with disseminated adenoviral disease. The current report documents clearance of disseminated ADV infection in a liver transplant recipient receiving CDV infusions.

AB - Background. No definitive antiviral therapy exists for adenovirus (ADV) in immunosuppressed hosts. Cidofovir (CDV), a broad spectrum anti-DNA viral agent, has previously been shown to be of therapeutic benefit in life-threatening adenoviral disease in bone marrow stem-cell recipients. Methods. A 71/2-month-old girl with a history of biliary atresia developed fevers, hematochezia, tachypnea, and laboratory evidence of hepatitis and pancreatitis 12 days after liver transplantation. A stool culture, oropharyngeal culture, blood viral culture, and blood polymerase chain reaction (PCR) confirmed ADV. Cidofovir 1 mg/kg intravenously three times per week was initiated. The patient received intravenous hydration and probenecid with the infusions to reduce the nephrotoxicity of CDV. Immunosuppression was reduced to achieve tacrolimus trough levels of approximately 8 ng/mL and prednisone at 0.1 mg/kg per day. Complete blood cell count, urinalysis, and viral studies were obtained weekly. Results. Detection of ADV DNA by PCR made a transition from positive to negative during CDV therapy. Blood viral cultures became negative after two CDV doses. Alanine aminotransferase normalized by 5 weeks of therapy. CDV was discontinued after 7 weeks secondary to transient acidosis and proteinuria. The patient never developed azotemia, neutropenia, or ocular abnormalities. Conclusions. CDV was associated with improved clinical status, viral clearance, and minimal transient side effects in a pediatric liver transplant recipient with disseminated adenoviral disease. The current report documents clearance of disseminated ADV infection in a liver transplant recipient receiving CDV infusions.

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