A Multicenter Consortium to Define the Epidemiology and Outcomes of Pediatric Solid Organ Transplant Recipients With Inpatient Respiratory Virus Infection

Journal of the Pediatric Infectious Diseases Society - Tập 8 Số 3 - Trang 197-204 - 2019
Lara Danziger‐Isakov1, William J. Steinbach2, Grant Paulsen1, Flor M. Muñoz3, Leigh R. Sweet3, Michael Green4, Marian G. Michaels4, Janet A. Englund5, Alastair Murray5, Natasha Halasa6, Daniel E. Dulek6, Rebecca Pellett Madan7, Betsy C. Herold7, Brian T. Fisher8,9,10
1Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio
2Departments of Pediatrics and Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
3Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston
4Division of Infectious Diseases, Children's Hospital of Pittsburgh of UPMC, and Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pennsylvania
5Seattle Children's Research Institute, Seattle Children's Hospital, and University of Washington
6Division of Pediatric Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
7Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York.
8Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
9Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania
10Division of Infectious Diseases, Department of Pediatrics, Pennsylvania

Tóm tắt

Abstract Background Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear. Methods A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant. An RVI diagnosis required respiratory symptoms and detection of a virus (ie, human rhinovirus/enterovirus, human metapneumovirus, influenza virus, parainfluenza virus, coronavirus, and/or respiratory syncytial virus). The incidence of RVI was calculated, and the association of baseline SOT factors with subsequent pulmonary complications and death was assessed. Results Of 1096 pediatric SOT recipients (448 liver, 289 kidney, 251 heart, 66 lung, 42 intestine/multivisceral), 159 (14.5%) developed RVI associated with hospitalization within 12 months after their transplant. RVI occurred at the highest rates in intestine/abdominal multivisceral (38%), thoracic (heart/lung) (18.6%), and liver (15.6%) transplant recipients and a lower rate in kidney (5.5%) transplant recipients. RVI was associated with younger median age at transplant (1.72 vs 7.89 years; P < .001) and among liver or kidney transplant recipients with the receipt of a deceased-donor graft compared to a living donor (P = .01). The all-cause and attributable case-fatality rates within 3 months of RVI onset were 4% and 0%, respectively. Multivariable logistic regression models revealed that age was independently associated with increased risk for a pulmonary complication (odds ratio, 1.24 [95% confidence interval, 1.02–1.51]) and that receipt of an intestine/multivisceral transplant was associated with increased risk of all-cause death (odds ratio, 24.54 [95% confidence interval, 1.69–327.96]). Conclusions In this study, hospital-associated RVI was common in the first year after pediatric SOT and associated with younger age at transplant. All-cause death after RVI was rare, and no definitive attributable death occurred.

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Thông tin xuất bản

Journal of the Pediatric Infectious Diseases Society

Tập 8 Số 3

197-204

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