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BACKGROUND Kidney transplant (KT) recipients in dengue-endemic areas are at risk of exposure. We investigated the epidemiology and outcomes from dengue in KT recipients at our transplant center and conducted a literature review. MATERIALS AND METHODS We conducted a 20-year retrospective study of KT recipients who were diagnosed with laboratory-confirmed dengue from January 1997 to September 2017 according to the 2009 World Health Organization (WHO) classification. We analyzed clinical characteristics and treatment outcomes. RESULTS There were 13 (0.7%) dengue cases among 1917 KT recipients with a median age of 39 years (interquartile ranges [IQR], 22-46); 54% were males. Cases occurred with a median onset of 24 months (IQR, 6-122) after KT. Dengue was diagnosed via dengue NS1 antigen (85%), IgM antibodies (38.5%), or RT-PCR (15.4%). Patients were classified as having dengue without warning sign (30.8%), with warning sign (53.8%), or severe dengue (15.4%). All patients resolved without complications, except one had hemophagocytic lymphohistiocytosis. Ten (76.9%) patients experienced eGFR reduction with a median of 13.7 mL/min/1.73 m2 (IQR, 8.3-20.5); eight (80%) had a full allograft function recovery. CONCLUSIONS Dengue in KT recipients in endemic areas is uncommon. Although a transient decline in allograft function can occur, the overall clinical and allograft outcomes seem to be favorable.

Background Adenovirus (ADV) infection after kidney transplantation (KT) can range from asymptomatic to severe disease. Cell-mediated immunity plays an important role in preventing disease progression. We aimed to investigate the role of absolute lymphocyte count (ALC) and ADV-specific CD8+ T cell immunity to predict the severity of ADV infection in KT recipients Methods We included all adult KT recipients with ADV infection at a single transplant center between January 2015 and March 2018. ADV infection/disease were defined as detectable ADV DNA load in plasma/plus symptoms. We defined severe ADV disease as having plasma ADV DNA load >6.0 log copies/mL and/or disseminated disease (≥2 specific organ symptoms). ADV specific CD8+ T cells were stimulated with whole ADV peptide, stained by intracellular cytokine staining and interrogated by flow cytometry. ALC (all patients) and ADV-specific CD8+ T-cell (7 index cases) were measured at diagnosis. The association of ALC and disease progression were assessed in those with and without severe disease. Results ADV infection was diagnosed in 14 KT recipients, 12 (86%) patients were male with a median age of 44 (IQR, 37–58) years. Ten (71%) recipients underwent deceased donor KT and none received anti-thymocyte globulin for induction therapy. ADV infection occurred at median of 14 (IQR, 2–37) months after KT. Eight (57%) recipients were defined as having severe ADV disease including disseminated ADV disease (n = 5). Median peak plasma ADV load was higher in those with severe disease compared with those without severe disease [6.0 (IQR 5.9–6.0) vs. 5.3 (IQR 3.9–5.4) log copies/mL (P = 0.003)]. Median ALC and ADV-specific CD8+ T cells at diagnosis were 1,000 (IQR 623–1,350) and 0.003 cells/mm3, respectively. KT recipients with severe disease had lower median ALC at diagnosis compared with those without severe disease [714 (IQR 419–860) vs. 1,264 (IQR 972–2,086) cells/mm3; P = 0.04) (Figure 1). Those with ALC