A Multicenter Consortium to Define the Epidemiology and Outcomes of Pediatric Solid Organ Transplant Recipients With Inpatient Respiratory Virus Infection
Tóm tắt
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.
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.
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]).
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.
Từ khóa
Tài liệu tham khảo
US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2013, Child health USA 2012
Flagg, 2010, Novel 2009 H1N1 influenza virus infection requiring extracorporeal membrane oxygenation in a pediatric heart transplant recipient, J Heart Lung Transplant, 29, 582, 10.1016/j.healun.2009.11.600
Evashuk, 2008, Respiratory failure associated with human metapneumovirus infection in an infant posthepatic transplant, Am J Transplant, 8, 1567, 10.1111/j.1600-6143.2008.02278.x
Blanchard, 2006, Significant morbidity associated with RSV infection in immunosuppressed children following liver transplantation: case report and discussion regarding need of routine prophylaxis, Pediatr Transplant, 10, 826, 10.1111/j.1399-3046.2006.00583.x
Gavaldà, 2012, Influenza A H1N1/2009 infection in pediatric solid organ transplant recipients, Transpl Infect Dis, 14, 584, 10.1111/tid.12005
Lo, 2013, The impact of RSV, adenovirus, influenza, and parainfluenza infection in pediatric patients receiving stem cell transplant, solid organ transplant, or cancer chemotherapy, Pediatr Transplant, 17, 133, 10.1111/petr.12022
Tran, 2013, Lower respiratory tract viral infections in pediatric abdominal organ transplant recipients: a single hospital inpatient cohort study, Pediatr Transplant, 17, 461, 10.1111/petr.12093
Robinson, 2015, Respiratory syncytial virus infections in pediatric transplant recipients: a Canadian Paediatric Surveillance Program study, Pediatr Transplant, 19, 659, 10.1111/petr.12553
Kumar, 2010, Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study, Lancet Infect Dis, 10, 521, 10.1016/S1473-3099(10)70133-X
Liu, 2009, Respiratory viral infections within one year after pediatric lung transplant, Transpl Infect Dis, 11, 304, 10.1111/j.1399-3062.2009.00397.x
Fisher, 2017, A multicenter consortium to define the epidemiology and outcomes of inpatient respiratory viral infections in pediatric hematopoietic stem cell transplant recipients, J Pediatric Infect Dis Soc
Fisher, 2016, Symptomatic respiratory virus infection and chronic lung allograft dysfunction, Clin Infect Dis, 62, 313, 10.1093/cid/civ871
Sayah, 2013, Rhinovirus and other respiratory viruses exert different effects on lung allograft function that are not mediated through acute rejection, Clin Transplant, 27, E64, 10.1111/ctr.12054
Apalsch, 1995, Parainfluenza and influenza virus infections in pediatric organ transplant recipients, Clin Infect Dis, 20, 394, 10.1093/clinids/20.2.394
Kumar, 2010, Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study, Lancet Infect Dis, 10, 521, 10.1016/S1473-3099(10)70133-X
Liu, 2010, Long-term impact of respiratory viral infection after pediatric lung transplantation, Pediatr Transplant, 14, 431, 10.1111/j.1399-3046.2010.01296.x
Bridges, 1998, Adenovirus infection in the lung results in graft failure after lung transplantation, J Thorac Cardiovasc Surg, 116, 617, 10.1016/S0022-5223(98)70168-0