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Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study.
Am J Transplant. 2019 12; 19(12):3284-3298.AJ

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.

Authors+Show Affiliations

Washington University in St. Louis, St. Louis, Missouri.Rho Federal Systems, Chapel Hill, North Carolina.Lucile Packard Children's Hospital, Palo Alto, California.Nationwide Children's Hospital, Columbus, Ohio.Department of Medicine, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.Cystic Fibrosis Foundation, Bethesda, Maryland.Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Texas Children's Hospital, Houston, Texas.Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.National Institutes of Health, NIAID, Bethesda, Maryland.Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.Washington University in St. Louis, St. Louis, Missouri.Boston Children's Hospital, Boston, Massachusetts.National Institutes of Health, NIAID, Bethesda, Maryland.Rho Federal Systems, Chapel Hill, North Carolina.Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31216376

Citation

Sweet, Stuart C., et al. "Absence of Evidence That Respiratory Viral Infections Influence Pediatric Lung Transplantation Outcomes: Results of the CTOTC-03 Study." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 19, no. 12, 2019, pp. 3284-3298.
Sweet SC, Chin H, Conrad C, et al. Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study. Am J Transplant. 2019;19(12):3284-3298.
Sweet, S. C., Chin, H., Conrad, C., Hayes, D., Heeger, P. S., Faro, A., Goldfarb, S., Melicoff-Portillo, E., Mohanakumar, T., Odim, J., Schecter, M., Storch, G. A., Visner, G., Williams, N. M., Kesler, K., & Danziger-Isakov, L. (2019). Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 19(12), 3284-3298. https://doi.org/10.1111/ajt.15505
Sweet SC, et al. Absence of Evidence That Respiratory Viral Infections Influence Pediatric Lung Transplantation Outcomes: Results of the CTOTC-03 Study. Am J Transplant. 2019;19(12):3284-3298. PubMed PMID: 31216376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study. AU - Sweet,Stuart C, AU - Chin,Hyunsook, AU - Conrad,Carol, AU - Hayes,Don,Jr AU - Heeger,Peter S, AU - Faro,Albert, AU - Goldfarb,Samuel, AU - Melicoff-Portillo,Ernestina, AU - Mohanakumar,Thalachallour, AU - Odim,Jonah, AU - Schecter,Marc, AU - Storch,Gregory A, AU - Visner,Gary, AU - Williams,Nikki M, AU - Kesler,Karen, AU - Danziger-Isakov,Lara, Y1 - 2019/07/25/ PY - 2019/01/11/received PY - 2019/05/14/revised PY - 2019/06/11/accepted PY - 2020/12/01/pmc-release PY - 2019/6/20/pubmed PY - 2020/9/18/medline PY - 2019/6/20/entrez KW - alloantibody KW - autoantibody KW - autoimmunity KW - infection and infectious agents - viral KW - lung (allograft) function/dysfunction KW - lung transplantation/pulmonology KW - pediatrics KW - translational research/science SP - 3284 EP - 3298 JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am. J. Transplant. VL - 19 IS - 12 N2 - 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. SN - 1600-6143 UR - https://www.unboundmedicine.com/medline/citation/31216376/Absence_of_evidence_that_respiratory_viral_infections_influence_pediatric_lung_transplantation_outcomes:_Results_of_the_CTOTC_03_study_ L2 - https://doi.org/10.1111/ajt.15505 DB - PRIME DP - Unbound Medicine ER -