Cylex ImmuKnow测定稳定肝移植患者CD4+T淋巴细胞活性临床分析

目的 探讨中国人肝移植术后肝功能稳定患者ImmuKnow免疫细胞功能测定与临床免疫抑制状况的相关性.方法 收集46例肝移植术后肝功能稳定患者的临床资料,选取性别、年龄、病因、血常规、肝功能、肾功能、乙肝五项和丙肝病毒载量、CD淋巴细胞亚群、他克莫司血药谷浓度、ImmuKnow值作为观察指标,对术后肝功能稳定患者ImmuKnow值与其他各相关临床指标进行多因素回归分析.结果 肝移植术后(22±15)个月肝功能稳定患者ImmuKnow值为(203±114)ATPng/ml(38.47～524.06 ATP ng/ml).回归分析显示ImmuKnow值与白细胞计数、CD3+淋巴细胞绝对计数以及CD3+CD4+T淋巴细胞绝对计数有相关性(P<0.05).ImmuKnow值与他克莫司谷值浓度、他克莫司日用量以及患者性别、年龄及其他肝功能指标没有相关性(P>0.05).5例合并活动性丙型肝炎病毒感染者有较低的ImmuKnow值(<61 ATP ng/ml).结论 Cylex ImmuKnow检测可以用于稳定肝移植患者免疫抑制的监恻,具有潜在的临床应用价值.综合评价肝移植患者免疫状态需要联合ImmuKnow、T淋巴细胞亚群、血药浓度、肝功能指标检测等相关检查,才能有效指导肝移植受体免疫抑制剂的个体化使用.

Abstract：

Objective To identify the level of functional immunity as measured by the ImmuKnow assay in Chinese stable liver transplant recipients and to correlate these values with the dose and the trough levels of immunosuppressant, and with other clinical parameters of these patients. Methods Functional immune response was assessed by the ImmuKnow assay in 46 blood samples taken from 46 stable liver transplant recipients from Beijing Youan Hospital, Capital Medical University Liver Transplantation Center. Results The average ATP value in these stable liver transplant recipients was 203±114 ng/ml (range: 38.47 ATP ng/ml to 524.06 ATP ng/ml) at 22± 15 month post liver transplantation. There was no correlation either between ImmuKnow ATP values and the tacrolimus trough levels, or between ImmuKnow ATP values and the liver function (P<0. 05). Stepwise multiple regression analysis identified WBC and CD3+, CD3+ CD4+ as independent predictors of ImmuKnow assay levels when age, gender and underlying diagnosis were taken into account (P<0. 05). Five patients who were detected to have active HCV infection had lower ImmuKnow ATP values (<61 ng/ml). Conclusions The Cylex ImmuKnow assay ATP values were lower in Chinese stable liver transplant recipients compared with American patients. Further investigation is required to determine the role of the ImmuKnow assay in tailoring immunosuppressant therapy in liver transplant recipients.     

西罗莫司转换在肝移植受者中的应用

目的 西罗莫司是一种新型、高效、低肾毒性的免疫抑制剂.本研究旨在总结肝移植术后免疫抑制剂从普乐可复转向西罗莫司的临床经验.方法 回顾性分析中山大学附属第一医院从2004年1月到2008年1月间肝移植术后免疫抑制剂从普乐可复转向西罗莫司的病例(A组,32例);作为对照,同时分析同期肝移植术后免疫抑制剂从普乐可复转向环孢素的病例(B组,15例).结果 A组的转换成功率为34.5%,B组的转换成功率为46%,二组的差异无统计学意义(P>0.05).A组的肾功能在转换后保持正常,而B组的肾功能在转换后4个月出现异常.A组出现了雷帕霉素相关性副作用,但均得到较好控制.结论 肝移植术后,西罗莫司可以替代普乐可复以控制急性排斥反应.     

Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study

BACKGROUND: Liver transplant recipients are at high risk for multi-drug resistant infections because of broad-spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients. METHODS: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co-infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls. RESULTS: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty-eight non-VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4-348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non-VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group (6500 dollars vs. 1750; p = 0.02) as well. CONCLUSION: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non-VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.     

霉酚酸酯在肾移植后肝功能不良患者中的应用

目的 分析和评价肾移植后肝功能不良患者使用霉酚酸酯（ＭＭＦ）的有效性和安全性。方法 １２例患者术后免疫抑制方案为：９例采用环孢素Ａ（ＣｓＡ）、硫唑嘌呤（Ａｚａ）、泼尼松（Ｐｒｅｄ）;３例采用ＣｓＡ、Ｐｒｅｄ。发生肝功能不良后,停用Ａｚａ;９例采用三联治疗的患者,６例减少ＣｓＡ和量１／４－１／３,３例改用ＣｓＡ、Ｐｒｅｄ;３例采用二联治疗者,１例减少ＣｓＡ,２例停用ＣｓＡ;１２例均加用ＭＭＦ１．５～     

Double-blind, placebo-controlled trial of human lymphoblastoid interferon prophylaxis of cytomegalovirus infection in renal transplant recipients.

We have conducted a double-blind, placebo-controlled trial of human lymphoblastoid interferon prophylaxis of cytomegalovirus (CMV) infection in 74 renal transplant recipients. Interferon (3 x 10(6) units was given thrice weekly for the first 6 weeks, then twice weekly for a further 8 weeks. During the period of interferon therapy, the incidence of CMV excretion was lower in the interferon group (28% versus 50%, P = 0.065), mainly due to a significant reduction of CMV reactivation (9% versus 56%, P = 0.02). However, for the whole study period (including the follow-up period after interferon therapy), there was no difference in the incidence of CMV excretion (44% versus 53%). The onset of CMV excretion was delayed (8.2 +/- 0.8 to 20.9 +/- 5.5 weeks, P = 0.04). The duration of CMV excretion was also reduced (11.1 +/- 3.1 to 29.4 +/- 5.7 weeks, P = 0.008). The number of positive CMV isolates from urine and saliva was significantly less in the interferon group. There was no difference in the site of CMV excretion. Of the patients in the treatment group who excreted CMV, 43% developed disease as compared to 63% in the control group (difference not significant). There was also no significant difference in the severity of the CMV infection between the two groups. Benefit appears to be restricted to seropositive recipients of seronegative kidneys. The interferon regime used in this study was well tolerated, with mild fever being the only reported side-effect. No patient had to stop therapy because of toxicity. The incidence of rejection and graft loss was not different between the two groups.     

肝移植术后真菌感染患者免疫抑制方案的调整

目的 探讨肝移植术后真菌感染患者的免疫抑制方案。方法 我院器官移植中心从2004年1月至2005年12月实施376例成人肝移植，对术前、术中存在真菌感染危险冈素的59例患者采用IL-2（interleukin-2）受体单克隆抗体诱导方案，对术后发生真菌感染的患者在应用有效抗真菌药物的同时，调整其免疫抑制方案。结果 共有36例患者发生真菌感染，发生真菌感染的中位时间为术后19d（4～75d），其中无临床症状仅真菌培养阳性16例，20例患者出现临床感染症状，感染部位以呼吸道（11/20，55%）为主，4例患者死于严重感染。真菌菌株培养多为白色念珠菌（24/41，58.5%）。16例患者减少免疫抑制剂，20例有临床表现的患者停用免疫抑制剂，减药或停药过程中仅1例患者出现排斥反应。结论 真菌感染是肝移植术后的重要并发症，术前或术中存在真菌易感因素患者应采用IL-2受体单克隆抗体诱导方案，术后发生真菌感染的患者在应用有效抗真菌药物同时，应减少或停用免疫抑制药物。     

个体化免疫抑制方案在肝移植高危受者中的应用

目的　评价高危受者肝移植后采用个体化免疫抑制方案的意义。方法　根据受者术前情况的不同制定不同的免疫抑制方案 ,比较采用个体化免疫抑制方案的高危受者与采用常规免疫抑制方案的高危受者和普通受者肝移植术后肾功能衰竭、急性排斥反应、感染发生率 (包括细菌、真菌、巨细胞病毒感染 )以及院内死亡率。结果　采用个体化免疫抑制方案的高危受者肝移植术后肾功能衰竭、细菌及真菌感染的发生率以及院内死亡率均较采用常规免疫抑制方案的高危受者显著降低 (P<0 .0 5) ,与采用常规免疫抑制方案的普通受者相比 ,两个组上述指标的差异无显著性。结论　采用个体化免疫抑制方案较常规免疫抑制方案有更高的安全性 ,可以提高高危受者的肝移植成功率。     

Prophylactic fluconazole in liver transplant recipients: A randomized,double-blind,placebo-controlled trial

Background:Among persons who receive solid organ 0842 transplants, liver transplant recipients have the highest incidence of invasive fungal infection; however, no antifungal prophylaxis has been proven to be effective.Objective:To evaluate the efficacy and safety of prophylactic0842 fluconazole in liver transplant recipients.Design:Randomized, double-blind, placebo-controlled trial. 0842Setting:University-affiliated transplantation center.0842Patients:212 liver transplant recipients who received fluconazole0842 (400 mg/d) or placebo until 10 weeks after transplantation.Measurements:Fungal colonization, proven superficial 0842 or invasive fungal infection, drug-related side effects, and death.Results:Fungal colonization increased in 0842 patients who received placebo (from 60% to 90%) but decreased in patients who received fluconazole (from 70% to 28%). Proven fungal infection occurred in 45 of 104 placebo recipients (43%) but in only 10 of 108 fluconazole recipients (9%) (P < 0.001). Fluconazole prevented both superficial infection (29 of 104 placebo recipients became infected [28%] compared with 4 of 108 fluconazole recipients [4%]; P < 0.001) and invasive infection (24 of 104 placebo recipients became infected [23%] compared with 6 of 108 fluconazole recipients [6%]; P < 0.001). Fluconazole prevented infection by most Candida species, except C. glabrata. However, infection and colonization by organisms intrinsically resistant to fluconazole did not seem to increase. Fluconazole was not associated with any hepatotoxicity. Patients receiving fluconazole had higher serum cyclosporine levels and more adverse neurologic events (headaches, tremors, or seizures in 13 fluconazole recipients compared with 3 placebo recipients; P = 0.01). Although the overall mortality rate was similar in both groups (12 of 108 [11%] in the fluconazole group compared with 15 of 104 [14%] in the placebo group; P > 0.2), fewer deaths related to invasive fungal infection were seen in the fluconazole group (2 of 108 patients [2%]) than in the placebo group (13 of 104 patients [13%]) (P = 0.003).Conclusions:Prophylactic 0842 fluconazole after liver transplantation decreases fungal colonization, prevents superficial and invasive fungal infections, and has no appreciable hepatotoxicity. Although fluconazole prophylaxis is associated with fewer deaths from fungal infection, it does not improve overall survival. Patients receiving prophylactic fluconazole require close monitoring of serum cyclosporine levels to avoid neurologic toxicity.     

两剂激素联合两剂达利珠单抗及他克莫司的免疫抑制方案在肝移植中的应用

目的 探讨两剂激素联合两剂达利珠单抗及他克莫司(FK506)的免疫抑制方案在肝移植中应用的安全性及有效性.方法 中山大学附属第一医院器官移植中心2006年9月至2008年3月共实施成人肝移植74例,排除3例血型不合、4例围手术期死亡外,余67例纳人本研究,其中男性54例,女性13例,年龄28～66岁,平均(46.9±8.7)岁.将67例成人肝移植患者随机分为两组:传统免疫抑制方案(激素3个月撤离)组(n=35)和两剂激素免疫抑制方案组(n=32),比较两组术后代谢并发症、感染(含细菌、真菌及巨细胞病毒感染)及排斥反应的发生率的差异.结果 两组患者的术后早期高血糖发生率,高血糖患者使用胰岛素的平均剂量,随访期内糖尿病、高血压及感染的发生率的差异有统计学意义(P<0.05);术后早期高血压发生率及随访期内排斥反应的发生率和高脂血症发生率无明显差异(P0.05).结论 两剂激素的免疫抑制方案是安全有效的,其不增加急性排斥反应的发生率,并可显著减少长期使用激素引起的各种不良反应及并发症的发生.     

Post‐transplant lymphoproliferative disorder in adult liver transplant recipients: a South American multicenter experience

Post‐transplant lymphoproliferative disorder (PTLD) is a major and potentially life‐threatening complication after solid‐organ transplantation. The aim of this study was to describe the disease characteristics, clinical practices, and survival related to PTLD in adult orthotopic liver transplant (OLT) recipients in South America. We conducted a survey at four different transplant groups from Argentina, Brazil, and Chile. Among 1621 OLT recipients, 27 developed PTLD (1.7%); the mean age at diagnosis was 53.7 (±14) yr with a mean time of 39.7 (±35.2) months from OLT to PTLD diagnosis. Initial therapy included reduction in immunosuppression alone in 23.1% of the patients. Either rituximab or chemotherapy was employed as initial or second‐line therapy in 76.9% of the patients. PTLD location was frequently extranodal (80.7%) and mostly involving the transplanted liver (59.3%). The overall survival at one and five yr post‐PTLD diagnosis was 53.8% and 46.2%, respectively. Significant univariate risk factors for post‐PTLD mortality included lactate dehydrogenase ≥250 U/L (HR 9.66, p = 0.02), stage III/IV PTLD (HR 5.34, p = 0.004), and HCV infection (HR 7.68, p = 0.01). In conclusion, PTLD in OLT adult recipients is predominantly extranodal, and although mortality is high, long‐term survival is possible.     

中国成人肝移植受体服用微乳化环孢素A两小时后浓度监测

目的评估微乳化环孢素A(CsAME)服用2h后药物浓度(C2)监测的安全性和可靠性,初步确定适合中国成人肝移植受体的C2目标浓度。方法将53例肝移植术后1～2个月的中国成人肝移植受体随机分为C0组(n=17)、高浓度C2组(n=18)、低浓度C2组(n=18),每组均设定了相应的目标浓度,随访期间定期监测CsA浓度、心、肝、肾功能、机体免疫状态及排斥反应的发生情况。结果低浓度C2组口服CsA的剂量最低,仅为2.51±0.37mg·kg-1·d-1,与C0组和高浓度C2组相比差异具有显著性(P<0.01)。低浓度C2组心、肝、肾功能受损程度最小,高浓度C2组受损伤程度最重。低浓度C2组的CD+4/CD+8T细胞比值为1.04±0.68,与C0组无显著性差异(P>0.05)。各组的排斥反应发生率无显著性差异。低浓度C2组的临床获益率最高(72.22%),高浓度C2组最低(11.11%)。结论通过设定合理的目标浓度,C2监测可以提供更合理的CsA口服剂量,在明显降低毒副作用的同时不增加排斥反应的发生率。适合中国成人肝移植受体的术后CsAMEC2目标浓度初步确定为:术后1～6个月600～800ng/ml,术后7～12个月400～600ng/ml。     

两种方案预防肝移植术后巨细胞病毒再感染的临床疗效观察

目的 分析针对性预防方案（targeted prophylaxis）和普遍性预防方案（universal prophylaxis）在预防肝移植术后巨细胞病毒（cytomegalovirus，CMV）再感染中的临床疗效。方法 回顾性分析入选本研究的62例肝移植病人的临床资料。按术后预防CMV再感染方案的不同分为A、B两组。A组（针对性预防方案）：针对高危病例术后应用更昔洛韦预防CMV再感染。B组（普遍性预防方案）：所有病例术后常规应用更昔洛韦预防CMV再感染。对两组病人的CMV再感染率、CMV再感染相关死亡率、CMV病发生率、术后平均住院时间、病人1年生存率及预防和治疗CMV再感染的相关费用作统计分析。结果 CMV再感染率为14．5％（9／62）。A组40例，术后6例（15％，6／40）发生CMV再感染，均为无临床症状的CMV活动性感染，其中5例治愈，1例死于上消化道大出血（与CMV再感染无关）。B组22例，术后3例（13．6％，3／22）发生CMV再感染，2例无临床症状病人治愈，1例CMV肝炎病人最终死于肝功能衰竭。CMV再感染率、CMV再感染相关死亡率、CMV病发生率、术后平均住院时间及病人1年生存率两组间均无明显差异（P〉0．05）。B组用于预防和治疗CMV再感染的人均费用明显高于A组（P〈0．01）。结论 肝移植术后两种方案预防CMV再感染的临床疗效相当。相比之下，针对性预防方案更为经济，适合于我国的肝移植受体。     

肝移植受者照顾者真实照护体验的质性研究

目的了解肝移植受者照顾者在照料患者期间的感受,为针对性干预提供依据。方法采用质性研究中的现象学研究方法,对肝移植受者照顾者16人进行半结构式深度访谈后对资料进行归纳分析。结果提炼出照护任务繁重、心理负担过重、缺乏专业支持、适应角色转变、实现自我价值5个主题。结论肝移植受者照顾者存在较重的心身压力,医护人员在对肝移植患者进行随访的同时,需对其照顾者提借知识指导及心理支持,以减轻照顾者心身负担。     

肾移植术后口服伐昔洛韦预防巨细胞病毒性肺炎的观察

目的探讨口服伐昔洛韦（valaciclovir）预防肾移植术后巨细胞病毒（CMV）性肺炎的有效性和安全性。方法前瞻性研究121例肾移植的临床资料，其中供、受者血清CMV-IgG均为阳性（D＋R＋组）肾移植63例，供者血清CMV-IgG阳性、受者血清CMV-IgG阴性（D＋R-组）肾移植58例。上述两组受者随机再分为预防组和对照组，预防组口服伐昔洛韦，对照组不给予抗病毒药物。观察肾移植术后1年内CMV性肺炎的发生率。结果预防组的受者对口服伐昔洛韦有良好的耐受性。预防组CMV性肺炎发生率为8．06％，对照组为22．03％，两组比较，差异有统计学意义（P〈0．05）。结论对供者血清CMV-IgG阳性、受者血清CMV-IgG阴性或供、受者血清CMV-IgG均为阳性的肾移植，受者预防性口服伐昔洛韦可以安全有效地降低术后CMV性肺炎的发生率。     

黄连素对肾移植患者环孢素A血浓度的影响

目的　研究黄连素对环孢素A（CsA）血浓度的影响。方法　将50例同种异体肾移植术后的患者随机分为2组。1组为黄连素组,30例;另1组为对照组,20例。用黄连素前测定所有受者的CsA血浓度谷值。黄连素用量为0.2g,每日3次,7d后复测所有受者的CsA血浓度值,同时测定肝、肾功能,观察期间免疫抑制剂用量不变,不用其它影响CsA血浓度的药物。结果　服用黄连素后CsA血浓度与服黄连素前相比显著升高,P＜0.001。结论　黄连素可提高CsA血浓度,与CsA联合应用可减少CsA用量。     

Tuberculosis in liver transplant recipients: prophylaxis in an endemic area

Background

Tuberculosis (TB) has a high prevalence in Brazil. The scenario of liver transplantation (LT) creates challenges: atypical presentation, treatment hepatotoxicity, and increased mortality. The majority of TB cases after transplantation represent reactivation of latent infections; therefore, prophylaxis (PX) plays a major role. The aim of this study was to evaluate the benefits of PX after LT based on a pretransplantation tuberculin test (TT) in an endemic area.

Methods

Retrospective analysis of medical data from 376 adult cirrhotic patients undergoing OLT from 2001 to 2009.

Results

Among 191 selected patients, 137 (71%) showed a pretransplant TT including 41 (30%) with a TT ≥5 mm. The 17 (40%) of these patients who were prescribed PX did not experience TB. Prophylaxis was discontinued in 5 patients (20%) owing to suspicion of hepatotoxicity (medium serum alanine transaminase 175 U/L). In the group without PX, we diagnosed 1 case of pulmonary TB. The overall prevalence of anergic patients in the cirrhotic phase was 65% and prevalence of TB 1%.

Conclusions

The prevalence of TB was similar to that reported in the literature, but positivity to TT was higher (34% vs 25%), possibly because of the endemicity of the area. There was a lower prevalence of extrapulmonary disease and no mortality. No patient undergoing PX with isoniazid, although incomplete due to suspicion of hepatotoxicity displayed TB. One patient without PX was affected by TB. The drug was effective but not always safe.     

原位肝移植术后真菌感染43例次诊治体会

目的 探讨原位肝移植术后真菌感染的诊断、治疗及预防。方法 回顾总结为175位患者所施行的180次原位肝移植的临床资料，并对可能导致真菌感染的危险因素进行统计学分析。结果 全组29例患者出现43例次真菌感染，感染率为16．6％(29／175)。其中念珠菌占98％(42／43)，曲霉菌2％(1／43)。发病中位时间为术后26d(3～96d)。常见感染部位依次是肺部37％(16／43)，肠管19％(8／43)和血液16％(7／43)。26例患者接受氟康唑治疗，感染严重的8例患者改用脂质体两性霉素B治疗。病死率45％(13／29)，直接与真菌感染有关的病死率为4．0％(7／175)。全胃肠外营养时间较长、抗生素治疗超过3周或出现肝动脉并发症的患者真菌感染的发生率显著增加。结论 真菌感染是影响肝移植生存率的重要原因之一。最常见的感染部位和病原菌分别是肺部和念珠菌。减少各种危险因素将有助于降低真菌感染的发生率。早期诊断和及时治疗是治愈的关键，严重的真菌感染应及时给予两性霉素B或其脂质体治疗。     

肝移植术后西罗莫司的替换治疗

目的 探讨肝移植术后应用西罗莫司的抗排斥替换治疗效果。方法 回顾性分析50例肝移植或肝肾联合移植患者替换西罗莫司前后肝肾功能的改善情况及副作用和排斥反应的发生率。34例联合应用小剂量FK506，9例联合应用骁悉，2例联合应用新山地明。5例术后远期患者，替换前仅用FK506，替换后单用西罗莫司。结果 24例患者因肝功能不良而替换西罗莫司，其中16例（66．7％）肝功能明显改善；18例患者肾功能不良，其中13例（72．2％）在2个月内肾功能明显好转；8例患者因大剂量应用FK506但其浓度未达到6ng／ml而替换西罗莫司，移植术后肝肾功能恢复良好，未出现排斥反应。本组中应用西罗莫司后出现急性排斥反应3例（6％），改用FK506后急性排斥反应治愈。11例（22％）出现白细胞及血小板减少，9例（18％）胆固醇和甘油三酯升高。这些副作用均在西罗莫司应用1月后出现，当停药或对症处理后消失。本组中未出现肝动脉血栓形成、伤口愈合不良等并发症。结论 肝移植术后应用钙调磷酸酶抑制剂发生肝肾功能不良或不能达到理想药物浓度时，西罗莫司是有效的抗排斥替代药物。     

Adenovirus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

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.