ADENOVIRUS INFECTION OF THE RENAL-ALLOGRAFT WITH SPARING OF PANCREAS GRAFT FUNCTION IN THE RECIPIENT OF A COMBINED KIDNEY-PANCREAS TRANSPLANT

We report a case of adenovirus infection of the renal allograft in a c ombined kidney/pancreas transplant recipient. The clinical presentatio n was renal allograft failure, which eventually reversed. The pancreat ic graft function remained stable. A renal biopsy showed massive tubul ar necrosis associated with a prominent granulomatous reaction, The pr ocess had a striking regional distribution within the kidney with the injury and inflammation limited to the outer medulla. Adenovirus type 11 was isolated from renal tissue by culture, and adenovirus was demon strated by immunofluorescence and electron microscopy in the kidney bi opsy. Immunosuppression may result in unusual patterns of response to infectious agents. This case demonstrated tropism of the adenovirus to only selected tubules within the kidney, with sparing of other organ function including, specifically, the pancreas allograft, The differen tial diagnosis of a granulomatous reaction in the transplant kidney mu st be expanded to include viral infection, in particular, adenovirus.