Background: Adenoviruses (AdV) are DNA viruses that can cause significant morbidity and mortality rates up to 50% with disseminated disease. The incidence post-renal transplantation is up to 4.1%, with over 75% of infections occurring within the first 3 months post-transplant. After reducing immunosuppression (IS), cidofovir (CDV) is often given in severe cases; however, its nephrotoxicity and high mortality rates despite treatment limit its clinical utility. We report the successful treatment of disseminated AdV in kidney (K) and kidney-pancreas (KP) transplant recipients with brincidofovir (BCDV), the non-nephrotoxic experimental oral lipid-ester derivative of CDV.

Methods: Retrospective case series of all K and KP transplant recipients with a confirmed diagnosis of disseminated AdV infection treated with BCDV at Tampa General Hospital. Transplant, clinical, and AdV infection characteristics, treatment, and outcomes are described below.

Results: 4 patients (3 female, 1 male), median age of 49 years, were included. All were confirmed AdV positive by urine and blood PCR, 3 also through kidney allograft tissue or bone marrow (BM). Median time from transplant to AdV infection was 8 months. AdV infection was cleared from blood and urine at a median of 7 and 9 days, respectively, post-BCDV initiation. All patients' serum creatinine (SCr) returned near baseline, with the exception of 1 patient who experienced graft loss prior to BCDV initiation. Two patients experience gastrointestinal (GI) adverse effects (AE) potentially related to BCDV.

Conclusion: BCDV successfully treated disseminated AdV infection without nephrotoxicity.

CITATION INFORMATION: Bowman L., Baliga R., Mayer C. Brincidofovir for Disseminated Adenovirus in Kidney and Kidney-Pancreas Transplant Recipients: Report of a Case Series Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress