Clinical outcomes of adenovirus infection in allogeneic hematopoietic cell transplant recipients: A real-world propensity-matched analysis

Abstract Background: Adenovirus infection is a known complication following allogeneic hematopoietic stem cell transplant (AlloHSCT), but its long-term clinical impact is not well defined. Using a large real- world dataset, this study aimed to evaluate the impact of adenovirus infection on the long-term outcomes among AHSCT recipients. Methods: We conducted a retrospective cohort study utilizing the TriNetX global federated health research network using real-world multicentric data. Adult AlloHSCT recipients were divided into two cohorts based on adenovirus infection status. Propensity score matching (1:1) was applied to control for confounding variables, including hypertension, heart failure, diabetes mellitus, malnutrition, asthma, emphysema, race, and BMI. After matching, 39,250 patients were included in each group. Primary outcomes included all-cause mortality, hospital readmission, cardiovascular events, stroke, acute kidney injury (AKI), and intubation. Risk ratios (RR) with 95% confidence intervals (CI) and p-values were calculated to compare outcomes between the two groups. Results: After propensity score matching, 39,250 patients were included in each cohort. Both groups had similar distributions of comorbidities including hypertension, diabetes mellitus, malnutrition, asthma, emphysema, and race. Patients with adenovirus infection had significantly higher rates of cardiac arrest (1.4% vs. 1.1%, p < 0.001), new heart failure (6.6% vs. 5.9%, p< 0.001), acute myocardial infarction (1.5% vs. 1.4%, p = 0.020), acute kidney injury (17.5% vs. 12.8%, p < 0.001), hemorrhagic stroke (0.7% vs. 0.5%, p < 0.001), and intubation (5.6% vs. 3.4%, p < 0.001). Readmission rates were also higher in the adenovirus group (18.1% vs. 13.1%, p < 0.001). Interestingly, ischemic stroke (0.8% vs. 1.3%, p < 0.001) and all-cause mortality (27.7% vs. 29.8%, p < 0.001) were lower among adenovirus-positive patients. These findings reflect a complex pattern of long-term risks and potential survival bias among adenovirus-infected. AlloHSCT recipients. Conclusion: In this large, propensity-matched analysis, adenovirus infection following AlloHSCT was associated with increased long-term risks of cardiovascular and renal complications, intubation, and hemorrhagic stroke. However, patients with adenovirus infection had lower all-cause mortality and ischemic stroke rates. These findings underscore the need for long-term monitoring and risk-based management strategies in this population.