These updated guidelines from the
Infectious Diseases Community of Practice of the American Society of
Transplantation review the diagnosis, prevention, and management of
adenovirus infections after solid
organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including
pneumonitis,
colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus surveillance testing should not be performed in asymptomatic recipients. Serial quantitative PCR might play a role in the decision to initiate or assess response to
therapy in a symptomatic patient. The initial and most important components of
therapy remain supportive care and decrease in immunosuppression. The use of
antiviral therapy is not supported by prospective randomized clinical trials. However, intravenous
cidofovir is considered the standard practice for treatment of severe, progressive, or disseminated adenovirus disease in most transplant centers.
Intravenous immunoglobulin may be beneficial, primarily in a select group of patients with
hypogammaglobulinemia. Future approaches to treatment of adenovirus disease may include administration of adenovirus-specific T-cell
therapy.