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Approach to infection and disease due to adenoviruses in solid organ transplantation

Florescu, Diana F.a,b; Stohs, Erica J.a

Current Opinion in Infectious Diseases: August 2019 - Volume 32 - Issue 4 - p 300–306
doi: 10.1097/QCO.0000000000000558

Purpose of review Adenoviruses are an important cause of morbidity and mortality of solid organ transplant patients and remain a clinical challenge with regard to diagnosis and treatment. In this review, we provide an approach to identification and classification of adenovirus infection and disease, highlight risk factors, and outline management options for adenovirus disease in solid organ transplant patients.

Recent findings Additional clinical data and pathologic findings of adenovirus disease in different organs and transplant recipients are known. Unlike hematopoietic cell transplant recipients, adenovirus blood PCR surveillance and preemptive therapy is not supported in solid organ transplantation. Strategies for management of adenovirus disease continue to evolve with newer antivirals, such as brincidofovir and adjunctive immunotherapies, but more studies are needed to support their use.

Summary Distinguishing between adenovirus infection and disease is an important aspect in adenovirus management as treatment is warranted only in symptomatic solid organ transplant patients. Supportive care and decreasing immunosuppression remain the mainstays of management. Cidofovir remains the antiviral of choice for severe or disseminated disease. Given its significant nephrotoxic effect, administration of probenecid and isotonic saline precidofovir and postcidofovir infusion is recommended.

aTransplant Infectious Diseases Division

bTransplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska, USA

Correspondence to Diana F. Florescu, MD, 985400 Nebraska Medical Center, Omaha, NE 68198-5400, USA. Tel: +1 402 559 8609; e-mail:

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