Adenovirus (AdV) is increasingly recognized in solid organ transplants (SOT), with reported mortality exceeding 50%. Characterization of AdV infection in the pediatric SOT population is limited, with questions regarding the risk factors associated with morbidity and mortality. This study describes the clinical presentation and outcomes of AdV infection to inform strategies for prevention and treatment. We identified 1,023 pediatric SOT from Jan 2005-Jun 2017. Forty AdV infections were identified in 32 patients. The overall prevalence was 3.9%. Most infections were in liver (1.7%), kidney (1.2%) and heart (0.7%) transplant recipients. Seventy-eight percent of patients were ≤ 5 years of age at the time of infection and the prevalence was significantly higher in patients transplanted ≤5 years of age compared to >5 years (29 vs 3, p<0.0001). Median time to disease was 238 days post-transplant (~8 months) and mean time to disease was significantly faster in younger patients as compared to the older patients (< 12 months old = 57 days; 12-23mo = 191 days; 2-5y = 427 days; 6-18y = 4303 days; p<0.001 for all comparisons). All patients were symptomatic at the time of diagnosis and the most common presenting symptom was fever (n=29, 73%). Most had AdV isolated from 1 or 2 sites (83%) with only 7 patients with >3 positive specimens. There was no difference between the number of positive specimens when comparing the younger (≤5) and older groups. The majority of patients were treated supportively and only 6 (15%) received cidofovir. In the latter group, 83% were < 3 years of age. There was no attributable mortality in our cohort. This data shows the majority of AdV infections occur in liver transplant recipients in the pediatric SOT population. There is an inverse relationship between age at time of disease and time from transplant, with a peak period of infectivity in the first year after transplantation. This adds to our knowledge about the high-risk group of likely naïve children ≤ 5 years of age. Disease in infants progresses the most rapidly, but the majority of disease was in the first year after transplant. Importantly, we showed a spectrum of disease that includes mild, self-resolving infection that can be managed with supportive care, and that AdV is typically not disseminated. Future studies will include both host and viral risk factors to define low and high risk groups.

CITATION INFORMATION: Del Valle Mojica C., Chen S., Gans H. Host Factors and Clinical Spectrum of Adenovirus Infection in Pediatric Solid Organ Transplantation: A Closer Look at the Infant, the Toddler and the Child Am J Transplant. 2017;17 (suppl 3).

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