Based on reports in adult lung transplant recipients, we hypothesized that community-acquired respiratory viral infections (CARVs) would be a risk factor for poor outcome after pediatric lung transplant. We followed 61 pediatric lung transplant recipients for 2+ years or until they met a composite primary endpoint including bronchiolitis obliterans syndrome/obliterative bronchiolitis, retransplant, or death. Blood, bronchoalveolar lavage, and nasopharyngeal specimens were obtained with standard of care visits. Nasopharyngeal specimens were obtained from recipients with respiratory viral symptoms. Respiratory specimens were interrogated for respiratory viruses by using multiplex polymerase chain reaction. Donor-specific HLA antibodies, self-antigens, and ELISPOT reactivity were also evaluated. Survival was 84% (1 year) and 68% (3 years). Bronchiolitis obliterans syndrome incidence was 20% (1 year) and 38% (3 years). The primary endpoint was met in 46% of patients. CARV was detected in 156 patient visits (74% enterovirus/rhinovirus). We did not find a relationship between CARV recovery from respiratory specimens and the primary endpoint (hazard ratio 0.64 [95% confidence interval: 0.25-1.59], P =.335) or between CARV and the development of alloimmune or autoimmune humoral or cellular responses. These findings raise the possibility that the immunologic impact of CARV following pediatric lung transplant is different than that observed in adults.
Bibliographical noteFunding Information:
This research was performed as a project of the Clinical Trials in Organ Transplantation in Children, a collaborative clinical research project headquartered at the National Institute of Allergy and Infectious Diseases. The work was supported by Grant U01 AI077810 ?Viral Triggers of Alloimmunity and Autoimmunity in Pediatric Lung Transplantation? from the Division of Allergy, Immunology and Transplantation of the National Institutes of Health.
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
- infection and infectious agents – viral
- lung (allograft) function/dysfunction
- lung transplantation/pulmonology
- translational research/science