1. Case StudyOne Pediatric Patient’s Experience Shelley Chapman RN, BSN, CCTC Children’s Hospital of Wisconsin

2. Patient History • 15 year old Caucasian male • Past medical history • Liver transplant • 3 year old • Fulminant liver failure of unknown etiology • Bone marrow transplant • 12 years old • Aplastic anemia • Kidney transplant • 13 years old • Immunosuppression

3. Patient Presentation • Presented to the Renal Clinic • 5 day history of dysuria • 2 day history of gross hematuria • Labs • Creatinine elevated at 1.49mg/dl • Increased from his baseline of 0.8mg/dl • Hospital admission • Further evaluation and presumed rejection • Renal ultrasound was done to evaluate for stones • IV fluids on the day of admission

4. Patient Presentation: The Next 48 Hours

5. Patient Presentation Cont.

6. Treatment • Recommended treatment for Adenovirus s/p BMT • Cidofovir and Probenecid • Side effect is nephrotoxicity • Alternate prodrugformulation of Cidofovir (CMX001) recommended • Drug currently in clinical trials

7. Treatment Continued • The Adenovirus PCR peaked at 137,000 copies • Slowly improved • Experienced intermittent fevers without bacteremia • Immunosuppression changes • DC Mycophenolate Mofetil • Continued on Tacrolimus and Prednisone • Patient discharged to home after 10 days

8. Outpatient Treatment & Follow-up

9. 1 Year Follow-up

10. Lessons Learned Do not assume patient is having rejection with sudden and substantial decline in renal function

11. Discussion and Questions