Format

Send to

Choose Destination
Am J Transplant. 2019 Dec;19(12):3284-3298. doi: 10.1111/ajt.15505. Epub 2019 Jul 25.

Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study.

Author information

1
Washington University in St. Louis, St. Louis, Missouri.
2
Rho Federal Systems, Chapel Hill, North Carolina.
3
Lucile Packard Children's Hospital, Palo Alto, California.
4
Nationwide Children's Hospital, Columbus, Ohio.
5
Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.
6
Cystic Fibrosis Foundation, Bethesda, Maryland.
7
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
8
Texas Children's Hospital, Houston, Texas.
9
Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
10
National Institutes of Health, NIAID, Bethesda, Maryland.
11
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
12
Boston Children's Hospital, Boston, Massachusetts.

Abstract

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.

KEYWORDS:

alloantibody; autoantibody; autoimmunity; infection and infectious agents - viral; lung (allograft) function/dysfunction; lung transplantation/pulmonology; pediatrics; translational research/science

PMID:
31216376
PMCID:
PMC6883118
[Available on 2020-12-01]
DOI:
10.1111/ajt.15505

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center