Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 23, Issue 1, Pages 93-100Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajt.2022.10.002
Keywords
Infectious disease; Liver transplantation/hepatology; Pediatrics
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Investigation into a recent cluster of acute hepatitis in children from the southeastern United States found human adenovirus (HAdV) DNAemia in all 9 cases. HAdV type 41 was identified in all cases, and two children progressed to pediatric acute liver failure (PALF) and required liver transplantation. This report highlights the importance of early multidisciplinary medical management and the feasibility of liver transplantation in children with PALF and HAdV DNAemia.
Investigation into a recent cluster of acute hepatitis in children from the southeastern United States identified human adenovirus (HAdV) DNAemia in all 9 cases. Molecular genotyping in 5 of 9 (56%) children identified HAdV type 41 in all cases (100%). Importantly, 2 children from this cluster progressed rapidly to pediatric acute liver failure (PALF) and required liver transplantation. HAdV type 41, a known cause of self-limited gastroen-teritis, has not previously been associated with severe cholestatic hepatitis and liver failure in healthy children. Adenovirus polymerase chain reaction assay and sequencing of amplicons performed on DNA extracted from formalin-fixed, paraffin-embedded liver tissue also identified adenovirus species F (HAdV type 40 or 41) in these 2 children with PALF. Transplant considerations and successful liver transplantation in such situations remain scarce. In this report, we describe the clinical course, laboratory results, liver pathology, and treatment of 2 children with PALF associated with HAdV type 41, one of whom developed secondary hemophagocytic lymphohistiocytosis. Their successful posttransplant outcomes demonstrate the importance of early multidisciplinary medical management and the feasibility of liver transplantation in some children with PALF and HAdV DNAemia.
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