Adenovirus infection in the lung results in graft failure after lung transplantation.
OBJECTIVE
Our goal was to examine the relationship between viral pneumonia and outcome in pediatric patients undergoing lung or heart-lung transplantation.


METHODS
Prospective surveillance for common respiratory viruses of childhood was performed in all patients undergoing lung or heart-lung transplantation. Specimens were examined for the presence of replicating virus (by culture), viral genome (by polymerase chain reaction), and viral antigen (by immunofluorescence and immunohistochemical staining). The relationship between viral infection and outcome was examined.


RESULTS
Sixteen patients underwent 19 transplants during the study period, with follow-up of 1 to 26 months. Virus was identified in the transplanted lung in 29 instances; adenovirus was identified most commonly (8/16 patients) and had the greatest impact on outcome. In 2 patients with early, fulminant infection, adenovirus was also identified in the donor. Adenovirus was significantly associated with respiratory failure leading to death or graft loss and with the histologic diagnosis of obliterative bronchiolitis (P < or = .002 in each case).


CONCLUSIONS
Adenovirus infection in the transplanted lung is significantly associated with graft failure, histologic obliterative bronchiolitis, and death. Health care personnel and families must be vigilant in preventing exposure of transplant recipients to this virus. Availability of a rapid and reliable test for adenovirus in donors and recipients would have an impact on management and could improve outcome for pediatric lung recipients.
Bridges
N D
ND
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
Spray
T L
TL
Collins
M H
MH
Bowles
N E
NE
Towbin
J A
JA
D000258:Adenovirus Infections, Human / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology*; D016027:Heart Transplantation / Q000473:pathology*; D016041:Heart-Lung Transplantation / Q000473:pathology*; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology; D008297:Male; D009894:Opportunistic Infections / Q000473:pathology*; D011024:Pneumonia, Viral / Q000473:pathology*; D011183:Postoperative Complications / Q000473:pathology; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000473:pathology