Disseminated adenovirus infection with respiratory failure in pediatric liver transplant recipients: Impact of intravenous cidofovir and inhaled nitric oxide

• Published in: Pediatric transplantation Vol. 10; no. 1; pp. 121 - 127
• Main Authors: Wallot, M. A., Dohna-Schwake, C., Auth, M., Nadalin, S., Fiedler, M., Malagó, M., Broelsch, C., Voit, T.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2006; Blackwell
• Subjects: acute respiratory distress syndrome; Adenovirus; Adenovirus Infections, Human - drug therapy; Adenovirus Infections, Human - etiology; Administration, Inhalation; Antiviral Agents - administration & dosage; Biliary Atresia - surgery; Biological and medical sciences; child; cidofovir; Cytosine - administration & dosage; Cytosine - analogs & derivatives; Female; Follow-Up Studies; Free Radical Scavengers - administration & dosage; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Immunosuppression - adverse effects; Infant; Liver Failure, Acute - surgery; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; nitric oxide; Nitric Oxide - administration & dosage; Organophosphonates - administration & dosage; Other diseases. Semiology; Pneumology; polymerase chain reaction; Postoperative Complications; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - etiology; Respiratory system : syndromes and miscellaneous diseases; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Pediatrics; Adenoviridae; Intravenous administration; Hepatic disease; Transplantation; Homotransplantation; Respiratory system infection; Liver failure; Respiratory failure; Surgery; Human adenovirus; adenovirus; Antiviral; Respiratory distress; Graft; Disseminated; Child; Human; Acyclic nucleotide; Respiratory disease; Acute; Organic phosphonate; Cidofovir; Syndrome; Inhalation; Graft failure; Infection; Virus; Polymerase chain reaction; Treatment; Nitric oxide; Viral disease; acute respiratory distress syndrome; Digestive diseases; Mastadenovirus; Molecular biology; Pyrimidine nucleotide; liver transplantation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2005.00411.x

:  Adenoviruses (AdV) are opportunistic pathogens that can lead to severe infections and respiratory failure (acute respiratory distress syndrome, ARDS) with high mortality in immunosuppressed patients. Cidofovir (CDV) has been used in adenoviral disease in bone marrow transplant recipients. Two pediatric liver transplant recipients with disseminated adenoviral disease and ARDS were treated with reduction of immunosuppression, CDV, and inhaled nitric oxide (iNO). CDV 1 mg/kg was given three times per week intravenously with intravenous hydration and oral probenecid. Viral suppression and clinical improvement was achieved. AdV hepatitis did not occur, and graft function was preserved, although acute rejection occurred in both patients. Adverse effects were mild and transient not requiring dose modification. Severe hypoxemia was reversed with iNO 10–20 p.p.m. CDV treatment of AdV infections in organ transplant recipients and other immunocompromised patients should be further investigated in prospective studies.