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J Thorac Cardiovasc Surg 1998;116:617-623
© 1998 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

ADENOVIRUS INFECTION IN THE LUNG RESULTS IN GRAFT FAILURE AFTER LUNG TRANSPLANTATION

Philadelphia, Pa, and Houston, Tex

From the Divisions of Pediatric Cardiology,^a Cardiothoracic Surgery,^b and Pathology,^c Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, and the Division of Pediatric Cardiology,^d Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.

Received for publication Feb 17, 1998. Revisions requested May 26, 1998; revisions received June 26, 1998. Accepted for publication June 29, 1998. Address for reprints: Nancy D. Bridges, MD, Medical Director, Thoracic Organ Transplantation, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104.

Objectives: 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 .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.

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