Pinchoff Rebecca J, Kaufman Stuart S, Magid Margret S, Erdman Dean D, Gondolesi Gabriel E, Mendelson Meryl H, Tane Kliti, Jenkins Stephen G, Fishbein Thomas M, Herold Betsy C
Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
Transplantation. 2003 Jul 15;76(1):183-9. doi: 10.1097/01.TP.0000072808.93060.0F.
The purpose of this study was to determine the prevalence of adenoviral infection in pediatric small bowel transplantation (SBT) recipients, examine risk factors for progression to histologic disease, and examine the impact of adenovirus on outcome.
Beginning in July 2000, all SBT recipients had viral cultures for adenovirus, cytomegalovirus (CMV), and herpes simplex virus (HSV) obtained routinely during graft biopsies. The medical records were retrospectively reviewed for frequency and site of viral culture, types and doses of immunosuppressive drugs, episodes of rejection, histology of allograft biopsies, and other infections. Adenoviral isolates were typed by polymerase chain reaction and type-specific neutralization assays.
All 14 SBT recipients who met enrollment criteria had evidence of adenoviral infection (intestinal graft, 13; liver graft, 1). Eight of 14 developed histologic disease with identifiable adenoviral intranuclear inclusions. In contrast, CMV enteritis was identified in only one patient, who subsequently also developed adenoviral disease. No other viruses were detected. Adenoviral cultures were first positive within 30 days of transplant in nine. Patients with histologic disease were more likely than those without to have received intensive corticosteroid therapy (P<0.007), had virus isolated from more than one site (P=0.03), and had persistent positive cultures (P<0.01).
Adenovirus was commonly isolated from children undergoing intestinal transplantation. Progression to disease may be associated with more intensive immunosuppressive therapy and inability to clear virus.
本研究的目的是确定小儿小肠移植（SBT）受者腺病毒感染的患病率，研究进展为组织学疾病的危险因素，并研究腺病毒对预后的影响。
从2000年7月开始，所有SBT受者在移植活检时常规进行腺病毒、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）的病毒培养。对病历进行回顾性审查，以了解病毒培养的频率和部位、免疫抑制药物的类型和剂量、排斥反应发作、移植活检的组织学以及其他感染情况。通过聚合酶链反应和型特异性中和试验对腺病毒分离株进行分型。
所有14名符合入组标准的SBT受者均有腺病毒感染的证据（肠移植，13例；肝移植，1例）。14例中有8例发展为具有可识别的腺病毒核内包涵体的组织学疾病。相比之下，仅1例患者被诊断为CMV肠炎，该患者随后也发展为腺病毒疾病。未检测到其他病毒。9例患者的腺病毒培养在移植后30天内首次呈阳性。发生组织学疾病的患者比未发生的患者更有可能接受强化皮质类固醇治疗（P<0.007），病毒从多个部位分离出来（P=0.03），并且培养持续呈阳性（P<0.01）。
腺病毒常见于接受肠道移植的儿童。疾病进展可能与更强化的免疫抑制治疗和无法清除病毒有关。
