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

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

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.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Bronchiolitis Obliterans / surgery*
  • Child
  • Child, Preschool
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / immunology
  • Community-Acquired Infections / virology*
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • Graft Rejection / immunology
  • Graft Rejection / virology*
  • Graft Survival / immunology*
  • Humans
  • Incidence
  • Infant
  • Longitudinal Studies
  • Lung Transplantation / adverse effects*
  • Male
  • Prognosis
  • Prospective Studies
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / immunology
  • Respiratory Tract Infections / virology*
  • Risk Factors
  • Transplant Recipients
  • Virus Diseases / epidemiology
  • Virus Diseases / immunology
  • Virus Diseases / virology*
  • Viruses / isolation & purification

Associated data

  • GENBANK/NCT00891865