A multicenter consortium to define the epidemiology and outcomes of pediatric solid organ transplant recipients with inpatient respiratory virus infection

Lara Danziger-Isakov, William J. Steinbach, Grant Paulsen, Flor M. Munoz, Leigh R. Sweet, Michael Green, Marian G. Michaels, Janet A. Englund, Alastair Murray, Natasha Halasa, Daniel E. Dulek, Rebecca Pellett Madan, Betsy Herold, Brian T. Fisher

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)197-204
Number of pages8
JournalJournal of the Pediatric Infectious Diseases Society
Volume8
Issue number3
DOIs
StatePublished - Jan 1 2019

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Virus Diseases
Respiratory Tract Infections
Inpatients
Epidemiology
Pediatrics
Transplants
Intestines
Lung
Kidney
Transplant Recipients
Cause of Death
Liver
Hospitalization
Logistic Models
Odds Ratio
Metapneumovirus
Confidence Intervals
Viruses
Satellite Viruses
Paramyxoviridae Infections

Keywords

  • Organ transplantation
  • Pediatrics
  • Respiratory virus infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases

Cite this

A multicenter consortium to define the epidemiology and outcomes of pediatric solid organ transplant recipients with inpatient respiratory virus infection. / Danziger-Isakov, Lara; Steinbach, William J.; Paulsen, Grant; Munoz, Flor M.; Sweet, Leigh R.; Green, Michael; Michaels, Marian G.; Englund, Janet A.; Murray, Alastair; Halasa, Natasha; Dulek, Daniel E.; Madan, Rebecca Pellett; Herold, Betsy; Fisher, Brian T.

In: Journal of the Pediatric Infectious Diseases Society, Vol. 8, No. 3, 01.01.2019, p. 197-204.

Research output: Contribution to journalArticle

Danziger-Isakov, L, Steinbach, WJ, Paulsen, G, Munoz, FM, Sweet, LR, Green, M, Michaels, MG, Englund, JA, Murray, A, Halasa, N, Dulek, DE, Madan, RP, Herold, B & Fisher, BT 2019, '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, vol. 8, no. 3, pp. 197-204. https://doi.org/10.1093/jpids/piy024
Danziger-Isakov, Lara ; Steinbach, William J. ; Paulsen, Grant ; Munoz, Flor M. ; Sweet, Leigh R. ; Green, Michael ; Michaels, Marian G. ; Englund, Janet A. ; Murray, Alastair ; Halasa, Natasha ; Dulek, Daniel E. ; Madan, Rebecca Pellett ; Herold, Betsy ; Fisher, Brian T. / A multicenter consortium to define the epidemiology and outcomes of pediatric solid organ transplant recipients with inpatient respiratory virus infection. In: Journal of the Pediatric Infectious Diseases Society. 2019 ; Vol. 8, No. 3. pp. 197-204.
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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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T1 - A multicenter consortium to define the epidemiology and outcomes of pediatric solid organ transplant recipients with inpatient respiratory virus infection

AU - Danziger-Isakov, Lara

AU - Steinbach, William J.

AU - Paulsen, Grant

AU - Munoz, Flor M.

AU - Sweet, Leigh R.

AU - Green, Michael

AU - Michaels, Marian G.

AU - Englund, Janet A.

AU - Murray, Alastair

AU - Halasa, Natasha

AU - Dulek, Daniel E.

AU - Madan, Rebecca Pellett

AU - Herold, Betsy

AU - Fisher, Brian T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Organ transplantation

KW - Pediatrics

KW - Respiratory virus infection

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