Adenoviral infections in pediatric liver transplant recipients

Abstract

Over a 5 1/2-year period, 22 of 262 children receiving liver transplants developed adenoviral infections. Five had adenoviral hepatitis in the allograft, caused by serotype 5. All five were treated for rejection, either just before or at the time of infection. Liver biopsy specimens had characteristic histological appearance, and diagnosis of adenoviral infection was confirmed with monoclonal antiadenoviral antibodies, electron microscopy, and by culture of liver tissue. In the remaining 17 patients, adenovirus was isolated from urine, stool, throat secretions, and/or blood samples, but none had any detectable visceral infection. Serotypes 1 and 2 predominated, similar to children not receiving transplants during the same time period. Three of the patients with hepatitis are alive and well; two died of liver failure. Adenoviral hepatitis did not recur in the second allograft of a patient who underwent retransplantation for combined rejection and adenoviral hepatitis, and appears, therefore, not to be a contraindication to retransplantation when liver failure ensues.

Fig 1

Adenovirus hepatitis, Left, Fairly circumscribed, punched-out lesions are filled with inflammatory cells (hematoxylin-eosin, original magnification × 97). Center, Inflammatory cell population consists of cells with oval or segmented nuclei. Necrosis is not conspicuous and nuclear inclusions may be hard to find (hematoxyhn-eosin, original. magnification × 250). Right, Staining of inflammatory cells with antilysozyme reveals dense, nongranular cytoplasmic distribution characteristic of monocytes (diaminobenzidine, original magnification × 330).

Fig 2

Adenovirus hepatitis, Left, Case 1 (autopsy), infected nuclei are larger than uninfected ones. Nuclear “inclusions” consist of a patchwork of waxy-appearing dense material with unstained clear zones (1 μm) (polychrome, original magnification × 330). Right, Case 1 (biopsy specimen) frozen section of liver with a granuloma. Section has been stained with antiadenovirus monoclonal antibody, revealing dense reaction product in enlarged hepatocytes (amino-ethylcarbazol, original magnification × 97).