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Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC‐03 study
Author(s) -
Sweet Stuart C.,
Chin Hyunsook,
Conrad Carol,
Hayes Don,
Heeger Peter S.,
Faro Albert,
Goldfarb Samuel,
MelicoffPortillo Ernestina,
Mohanakumar Thalachallour,
Odim Jonah,
Schecter Marc,
Storch Gregory A.,
Visner Gary,
Williams Nikki M.,
Kesler Karen,
DanzigerIsakov Lara
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15505
Subject(s) - medicine , bronchiolitis obliterans , lung transplantation , rhinovirus , bronchiolitis , bronchoalveolar lavage , immunology , clinical endpoint , transplantation , lung , respiratory system , clinical trial
Based on reports in adult lung transplant recipients, we hypothesized that community‐acquired respiratory viral infections ( CARV s) 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.