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

Sweet, Stuart C; Chin, Hyunsook; Conrad, Carol; Hayes, Don; Heeger, Peter S; Faro, Albert; Goldfarb, Samuel; Melicoff-Portillo, Ernestina; Mohanakumar, Thalachallour; Odim, Jonah; Schecter, Marc; Storch, Gregory A; Visner, Gary; Williams, Nikki M; Kesler, Karen; Danziger-Isakov, Lara

Based on reports in adult lung transplant recipients, we hypothesized that community acquired respiratory viral infections (CARV) 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 (BOS)/obliterative bronchiolitis, re-transplantation or death. Blood, bronchoalveolar lavage and nasopharyngeal specimens were obtained with standard of care visits. Nasopharyngeal specimens were obtained with respiratory viral symptoms. Respiratory specimens were interrogated for respiratory viruses using multiplex PCR. Donor-specific HLA antibodies, self-antigens, and Elispot reactivity were also evaluated. Survival was 84% (1 year) and 68% (3 years). BOS 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 (HR 0.64 (0.25, 1.59), P=0.335) or between CARV and the development of allo- 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. This article is protected by copyright. All rights reserved.