*Purpose: Intestinal transplant is a life-saving therapy for intestinal failure. Adenovirus Enteritis (AE) is an unusual infection identified on biopsy or serology following intestine or multivisceral transplantation. AE can complicate patient course following intestine and multivisceral transplantation. Solid organ transplant patients have an increased risk for infection and intestine and multivisceral patients are unique in that they often develop inflammation from rejection in the intestine which might predispose to infection.

*Methods: We reviewed patients who received an intestine transplant at three academic intestine transplant centers in the United States between 2010 and 2021 for demographic, laboratory and clinical data and outcomes.

*Results: Five patients were identified with diagnosis of adenovirus enteritis. Three patients (60%) had isolated intestine transplant while two underwent multivisceral transplant. Reason for transplant included trauma, volvulus, intestinal atresia and visceral neuropathy. All patients received induction with anti-thymocyte globulin thymoglobulin (80%) or basiliximab. The initial diagnosis of infection occurred at a mean of 26.8 months following transplant (range 2-68 months). Diagnosis was made by PCR measurement in plasma (80%), or inclusions on intestinal biopsy (20%). Cidofovir was used in 100% of cases as primary management. 40% of patients had reduction of immunosuppression at the time of diagnosis while the remainder did not. 60% of patients had rejection within a month prior to diagnosis. No patients had rejection within a month following treatment of the infection. Two patients had recurrent adenovirus infection following primary treatment. No patients had graft loss or death within 6 months following infection. Two patients had enterectomy at a mean of 29.5 months following infection (range 22-37 months) Three patients died at a mean of 32 months following diagnosis of AE (range 8-51 months).

*Conclusions: We present a series of patients with AE following intestinal or multivisceral transplant. AE may arise due to immunosuppression, vascular compromise of the transplanted organ, or a combination of factors. In our population, death or graft loss within six months was not seen following infection. Distinguishing the underlying causes and optimal treatment for AE in intestinal transplant patients may be achieved through larger studies.

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